Provider Demographics
NPI:1124058326
Name:WILLIAM C PORTER MD LTD
Entity type:Organization
Organization Name:WILLIAM C PORTER MD LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:CALVIN
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:701-235-0161
Mailing Address - Street 1:100 4TH ST S
Mailing Address - Street 2:STE 608
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-1929
Mailing Address - Country:US
Mailing Address - Phone:701-235-0161
Mailing Address - Fax:701-235-0332
Practice Address - Street 1:100 4TH ST S
Practice Address - Street 2:STE 608
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-1929
Practice Address - Country:US
Practice Address - Phone:701-235-0161
Practice Address - Fax:701-235-0332
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-03
Last Update Date:2008-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND5644207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND01167001OtherBCBS ND
MN2T995POOtherBCBS MN
MN2T995POOtherBCBS MN