Organization
BORIS PORTO, M.D., P.A.
Active
Organization
BORIS PORTO, M.D., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BORIS PORTO M.D. (PRESIDENT)
(806) 771-1386
Entity
Organization
Contact information
Practice address
4412 74TH ST, SUITE E102, LUBBOCK, TX 79424-2328
(806) 792-7843
(806) 792-7675
Mailing address
PO BOX 54136, LUBBOCK, TX 79453-4136
(806) 771-1386
(806) 771-1388
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
H4621
TX
2084P0804X
Child & Adolescent Psychiatry Physician
H4621
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0069RQ
BLUE CROSS BLUE SHIELD
TX
05
—
199787601
—
TX
Enumeration date
06/05/2008
Last updated
06/05/2009
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