1639116221 NPI number — DR. DAVID J PORTER M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639116221 NPI number — DR. DAVID J PORTER M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

PORTER

Provider First Name:

DAVID

Provider Middle Name:

J

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1639116221

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/07/2017

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

10700 E GEDDES AVE

Provider Second Line Business Mailing Address:

NO 200

Provider Business Mailing Address City Name:

ENGLEWOOD

Provider Business Mailing Address State Name:

CO

Provider Business Mailing Address Postal Code:

80112-3800

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

303-761-9190

Provider Business Mailing Address Fax Number:

720-874-4462

Provider First Line Business Practice Location Address:

8200 E BELLEVIEW AVE

Provider Second Line Business Practice Location Address:

600

Provider Business Practice Location Address City Name:

GREENWOOD VILLAGE

Provider Business Practice Location Address State Name:

CO

Provider Business Practice Location Address Postal Code:

80111-2803

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

303-761-9190

Provider Business Practice Location Address Fax Number:

720-874-4462

Provider Enumeration Date:

06/01/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2085R0202X , with the licence number:  41827 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 2085R0202X , with the licence number: 25146 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 2085R0202X , with the licence number: 04-36305 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 171543501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 10025709000 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
• Identifier: 104686310 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
• Identifier: 1639116221 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
• Identifier: 1639116221 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
• Identifier: 49400746 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
• Identifier: 84-059792913 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
• Identifier: 920555 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
• Identifier: 17205573 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
• Identifier: 200425430A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".