Organization
SAN MARCOS ANESTHESIOLOGY, LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHARLES T PORTER JR. M.D. (OWNER)
(512) 753-3627
Entity
Organization
Contact information
Practice address
1301 WONDER WORLD DR, SAN MARCOS, TX 78666-7533
(512) 753-3627
Mailing address
PO BOX 938, KILLEEN, TX 76540-0938
(254) 634-6999
(254) 200-4090
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00655T
BLUE CROSS BLUE SHIELD
TX
Enumeration date
06/10/2006
Last updated
01/28/2008
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