MEDICARE: FRANK O PORTER DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	05-21668	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417914490
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FRANK O PORTER DO

Provider Business Mailing Address
First Line	:	1408 EAST ST
Second Line	:
City	:	IOLA
State	:	KS
Zip	:	66749-4402
Country	:	US
Telephone Number	:	620-852-3550
Fax Number	:	620-852-3462

Provider Business Practice Location Address
First Line	:	1408 EAST ST
Second Line	:
City	:	IOLA
State	:	KS
Zip	:	66749-4402
Country	:	US
Telephone Number	:	620-365-3115
Fax Number	:	620-365-7717

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/26/2006
Last Update Date	:	01/24/2024

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Directions to “ FRANK O PORTER DO” Practice Location

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