Provider Demographics
NPI:1477791606
Name:PORTER, MATTHEW TIMOTHY (MD)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:TIMOTHY
Last Name:PORTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1081 EAST 18TH STREET
Mailing Address - Street 2:PO BOX 458
Mailing Address - City:ROLLA
Mailing Address - State:MO
Mailing Address - Zip Code:65401-8115
Mailing Address - Country:US
Mailing Address - Phone:573-426-6712
Mailing Address - Fax:573-426-6723
Practice Address - Street 1:1081 E 18TH ST
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-3398
Practice Address - Country:US
Practice Address - Phone:573-426-6712
Practice Address - Fax:573-426-6723
Is Sole Proprietor?:No
Enumeration Date:2009-01-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE26022207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine