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1205803608 NPI number — STEPHEN GREGORY PORTERA M.D.

NPI Number: 1205803608
Health Care Provider/Practitioner: STEPHEN GREGORY PORTERA M.D.

Information about “1205803608” NPI (STEPHEN GREGORY PORTERA M.D.) exists in 1205803608 in HTML format HTML  |  1205803608 in plain Text format TXT  |  1205803608 in PDF (Portable Document Format) PDF  |  1205803608 in an XML format XML  formats.

NPI Number : 1205803608 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1205803608",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PORTERA",
    "FirstName": "STEPHEN",
    "MiddleName": "GREGORY",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "965 RIDGE LAKE BLVD STE 315",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "MEMPHIS",
    "MailingAddressStateName": "TN",
    "MailingAddressPostalCode": "38120-9401",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": null,
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "6215 HUMPHREYS BLVD STE 110",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "MEMPHIS",
    "PracticeLocationAddressStateName": "TN",
    "PracticeLocationAddressPostalCode": "38120-2382",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "901-227-9610",
    "PracticeLocationAddressFaxNumber": "901-227-9615",
    "EnumerationDate": "03/03/2006",
    "LastUpdateDate": "03/30/2023",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "208800000X",
          "TaxonomyName": "Urology Physician",
          "LicenseNumber": "MD25742",
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "207V00000X",
          "TaxonomyName": "Obstetrics & Gynecology Physician",
          "LicenseNumber": "25742",
          "LicenseNumberStateCode": "TN",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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