Individual
DR. CHARLES THOMAS PORTER JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1301 WONDER WORLD DR, SAN MARCOS, TX 78666-7533
(512) 753-3627
(254) 200-4090
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
H5606
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050088140
RAILROAD MEDICARE
TX
01
—
125444306
SUPERIOR HEALTH CHIPS
TX
05
—
125444306
—
TX
01
—
8616B6
BLUE CROSS BLUE SHIELD
TX
Enumeration date
12/12/2005
Last updated
01/28/2008
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