Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | G2206 | TX |
Y | 2080P0204X | Pediatric Emergency Doctor | G2206 | TX |
NPI | 1114944048 |
---|---|
Provider Name | Dr. Edward A Porrata |
First Address | San Antonio, TX 78229-3141 |
Second Address | San Antonio, TX 78229 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2006 |
Last Update Date | 01/11/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
134962301 | (05) | TX |
134962307 | (05) | TX |
134962309 | (05) | TX |
83983F | BCBS (01) | TX |
8BW920 | BCBSTX (01) | TX |
D86937 | (02) | TX |