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General NPI Number Information
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NPI Number | 1205000239
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Entity Type | Individual
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Provider Name | DOUGLAS RYAN PORTER M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/22/2008
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 9811 W CHARLESTON BLVD STE 2-641
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City | LAS VEGAS
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State | NV
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Zip | 89117-7528
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Country | US
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Telephone | 855-864-4322
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Fax | 855-864-4322
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Provider Business Mailing Address
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Address Line | 336 22ND AVE N
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City | NASHVILLE
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State | TN
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Zip | 37203-1844
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Country | US
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Telephone | 615-346-8182
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Fax | 615-829-8970
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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 | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | A120368
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | E-9389
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 15545
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License Number State | NV
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Taxonomy #4
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | Q2939
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License Number State | TX
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Taxonomy #5
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 53712
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License Number State | CT
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Taxonomy #6
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 52179
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License Number State | TN
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Taxonomy #7
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | MD37652
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License Number State | SC
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Taxonomy #8
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 57094
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License Number State | AZ
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Taxonomy #9
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | TM2014-0671
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License Number State | NM
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Taxonomy #10
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | MD.35605
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License Number State | AL
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Taxonomy #11
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Taxonomy Code | 2084N0600X
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Taxonomy Name | Clinical Neurophysiology Physician
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License Number | 1988834
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License Number State | NY
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Taxonomy #12
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | MD60502147
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License Number State | WA
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