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General NPI Number Information
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NPI Number | 1851541270
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Entity Type | Individual
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Provider Name | MICHAEL LAWRENCE PORTER PA, SA-C
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Gender | Male
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Dates
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Enumeration Date | 09/22/2008
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Last Update Date | 02/12/2026
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Provider Practice Location Address
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Address Line | 2811 MANCHESTER LN
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City | GRAPEVINE
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State | TX
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Zip | 76051-4731
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Country | US
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Telephone | 214-227-2457
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Fax | 214-764-0880
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Provider Business Mailing Address
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Address Line | 2811 MANCHESTER LN
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City | GRAPEVINE
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State | TX
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Zip | 76051-4731
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Country | US
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Telephone | 214-227-2457
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Fax | 214-764-0880
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 4268
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA06738
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License Number State | TX
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