Basic Information
| Provider Information | |||||||||
| NPI: | 1497735575 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PORTER | ||||||||
| FirstName: | ALAN | ||||||||
| MiddleName: | HARRY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2234 COLONIAL BLVD | ||||||||
| Address2: | ATTN: PAYER CONTRACTING & RELATIONS | ||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339071412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2399317342 | ||||||||
| FaxNumber: | 2399317385 | ||||||||
| Practice Location | |||||||||
| Address1: | 3663 BEE RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 34233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9419248700 | ||||||||
| FaxNumber: | 9419212320 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2006 | ||||||||
| LastUpdateDate: | 03/11/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0203X | ME19991 | FL | N | Allopathic & Osteopathic Physicians | Radiology | Therapeutic Radiology | 2085R0001X | ME19991 | FL | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 1254471 | 01 | FL | CIGNA | OTHER | P950131 | 01 | FL | OPTIMUM | OTHER | P01257636 | 01 | FL | RAILROAD MCR | OTHER | 282563 | 01 | FL | AVMED | OTHER | P00350355 | 01 | R.R.MEDICARE | OTHER | 01201 | 01 | FL | BCBS OF FL | OTHER | P102612 | 01 | FL | FREEDOM HEALTH | OTHER | 042847700 | 05 | FL | MEDICAID |