MEDICARE: DR. LETICIA A PORET 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	207R00000X	Internal Medicine Physician	H9289	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	8755B9	OTHER	TX	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	8AJ423	OTHER	TX	BC BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578763462
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LETICIA A PORET MD PA

Provider Business Mailing Address
First Line	:	12627 STONEHENGE DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-1941
Country	:	US
Telephone Number	:	210-733-3005
Fax Number	:	210-733-3005

Provider Business Practice Location Address
First Line	:	4522 FREDERICKSBURG RD STE A14
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78201-6595
Country	:	US
Telephone Number	:	210-733-3005
Fax Number	:

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

Provider Enumeration Date	:	07/19/2007
Last Update Date	:	01/07/2008

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