Doctor Name: | THOMAS EUGENE PORTER |
NPI Number: | 1477567907 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MD |
License Number: | |
Business Practice Address: | 200 South Broadway St Goreville, IL - 629390040 |
Business Phone Number: | 6189952396 |
Business Fax Number: | 6189952947 |
Mailing Address: | Po Box 40, GOREVILLE |
State: | IL |
Postal Code: | 629390040 |
Phone Number: | 6189952396 |
Fax Number: | 6189952947 |
NPI Enumeration Date: | 07/28/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |