Provider Demographics
NPI:1699780767
Name:PORTER, BARBARA J (MD)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:J
Last Name:PORTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 26726
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78755-0726
Mailing Address - Country:US
Mailing Address - Phone:512-407-8686
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:11714 WILSON PARKE AVE, SUITE 150
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78726-4006
Practice Address - Country:US
Practice Address - Phone:737-247-7200
Practice Address - Fax:512-406-7368
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5867207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101551303Medicaid
TX101551301Medicaid
TX080148199Medicare PIN
TX101551303Medicaid
TX8600J1Medicare PIN