Individual
THOMAS PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2525 GLENN HENDREN DR, LIBERTY, MO 64068-9625
(816) 781-7200
(816) 781-7196
Mailing address
PO BOX 804408, KANSAS CITY, MO 64180-0001
(913) 647-4100
(913) 647-4120
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
04-22712
KS
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
2004006670
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
15158101
BCBS KC
MO
01
—
15158111
BCBS KC
MO
05
—
206955619
—
MO
Enumeration date
09/27/2005
Last updated
12/09/2020
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