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General NPI Number Information
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NPI Number | 1558379230
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Entity Type | Individual
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Provider Name | KRIS D PORTER MD
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Gender | Female
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 05/02/2020
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Provider Practice Location Address
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Address Line | 251 WESTPARK WAY STE 210
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City | EULESS
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State | TX
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Zip | 76040-3742
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Country | US
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Telephone | 512-800-3187
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Fax | 855-813-9308
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Provider Business Mailing Address
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Address Line | 94 BLUFF VW
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City | ALEDO
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State | TX
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Zip | 76008-4580
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Country | US
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Telephone | 512-800-3187
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Fax | 855-813-9308
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | J8509
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License Number State | TX
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