Individual
CLARENCE MILTON PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
14100 NACOGDOCHES RD, STE 116, SAN ANTONIO, TX 78247-1903
(210) 653-8989
(210) 590-4608
Mailing address
14100 NACOGDOCHES RD, STE 116, SAN ANTONIO, TX 78247-1903
(210) 653-8989
(210) 590-4608
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
F3292
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0994741-03
WELLMED MEDICAID
TX
01
—
84V623
WELLMED MEDICARE
TX
Enumeration date
07/07/2005
Last updated
10/18/2016
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