Provider Demographics
NPI:1366125544
Name:PORTER, MARCUS
Entity type:Individual
Prefix:
First Name:MARCUS
Middle Name:
Last Name:PORTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3833 TIERRA NUBE
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-4838
Mailing Address - Country:US
Mailing Address - Phone:954-646-1850
Mailing Address - Fax:
Practice Address - Street 1:3833 TIERRA NUBE
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-4838
Practice Address - Country:US
Practice Address - Phone:954-646-1850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-14
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor