Provider Demographics
NPI:1417914490
Name:PORTER, FRANK O (DO)
Entity type:Individual
Prefix:
First Name:FRANK
Middle Name:O
Last Name:PORTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408 EAST ST
Mailing Address - Street 2:
Mailing Address - City:IOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66749-4402
Mailing Address - Country:US
Mailing Address - Phone:620-852-3550
Mailing Address - Fax:620-852-3462
Practice Address - Street 1:1408 EAST ST
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:KS
Practice Address - Zip Code:66749-4402
Practice Address - Country:US
Practice Address - Phone:620-365-3115
Practice Address - Fax:620-365-7717
Is Sole Proprietor?:No
Enumeration Date:2006-04-26
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS05-21668207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100203440CMedicaid
045821Medicare ID - Type Unspecified
D78414Medicare UPIN