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General NPI Number Information
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NPI Number | 1154349389
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Entity Type | Individual
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Provider Name | STEPHANIE ANN PORTER M.D.
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Gender | Female
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 3564 N FOURTH ST STE A
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City | LONGVIEW
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State | TX
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Zip | 75605-0039
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Country | US
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Telephone | 903-230-3311
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Fax | 903-230-3312
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Provider Business Mailing Address
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Address Line | 3564 N FOURTH ST STE A
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City | LONGVIEW
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State | TX
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Zip | 75605-0039
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Country | US
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Telephone | 903-230-3311
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Fax | 903-230-3312
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | L3841
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License Number State | TX
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