MEDICARE: CARLOS PORTER, MD PA

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	261QF0050X	Non-Surgical Family Planning Clinic/Center

General Provider Information

NPI Number	:	1548475320
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CARLOS PORTER, MD PA

Provider Business Mailing Address
First Line	:	2829 BABCOCK RD STE 117
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78229-6009
Country	:	US
Telephone Number	:	210-341-9614
Fax Number	:	210-340-5924

Provider Business Practice Location Address
First Line	:	2318 PAT BOOKER RD
Second Line	:
City	:	UNIVERSAL CITY
State	:	TX
Zip	:	78148-3229
Country	:	US
Telephone Number	:	210-659-0323
Fax Number	:	210-659-7668

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	TAMMY RUIZ
Credential	:
Telephone Number	:	210-341-9614

Provider Enumeration Date	:	05/14/2007
Last Update Date	:	02/18/2022

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