MEDICARE: MITCHELL M PORIAS DO 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	207W00000X	Ophthalmology Physician	E4920	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4975890001	OTHER		PALMETTO

General Provider Information

NPI Number	:	1578540712
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MITCHELL M PORIAS DO PA

Provider Business Mailing Address
First Line	:	2030 N LOOP W
Second Line	:	#200
City	:	HOUSTON
State	:	TX
Zip	:	77018
Country	:	US
Telephone Number	:	713-681-5367
Fax Number	:	713-681-8202

Provider Business Practice Location Address
First Line	:	2030 N LOOP W
Second Line	:	#200
City	:	HOUSTON
State	:	TX
Zip	:	77018
Country	:	US
Telephone Number	:	713-681-5367
Fax Number	:	713-681-8202

Authorized Official
Title or Position	:	PRACTITIONER
Name	:	MITCHELL MILES PORIAS
Credential	:	DO
Telephone Number	:	713-681-6364

Provider Enumeration Date	:	12/29/2005
Last Update Date	:	12/07/2007

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