Individual
BRENT A PORTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
441 HIGHWAY 71 W, SUITE C, BASTROP, TX 78602-3931
(512) 304-0313
(512) 304-0326
Mailing address
1601 RIO GRANDE ST, SUITE 340, AUSTIN, TX 78701-1137
(512) 324-8960
(512) 324-8962
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
L1969
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
145173408
—
TX
Enumeration date
07/14/2006
Last updated
01/31/2013
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