Provider Demographics
NPI:1194072942
Name:PORTER, ALLERA
Entity type:Individual
Prefix:DR
First Name:ALLERA
Middle Name:
Last Name:PORTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 W HIGHWAY 90
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TX
Mailing Address - Zip Code:77535-2639
Mailing Address - Country:US
Mailing Address - Phone:936-258-7395
Mailing Address - Fax:936-258-4531
Practice Address - Street 1:209 W HIGHWAY 90
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TX
Practice Address - Zip Code:77535-2639
Practice Address - Country:US
Practice Address - Phone:936-258-7395
Practice Address - Fax:936-258-4531
Is Sole Proprietor?:No
Enumeration Date:2012-08-11
Last Update Date:2012-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX40809183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist