Basic Information
| Provider Information | |||||||||
| NPI: | 1861447047 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PORTER RADIAION ONCOLOGY PA | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | SARASOTA RADIATION & MEDICAL ONCOLOGY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3663 BEE RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342331003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9419248700 | ||||||||
| FaxNumber: | 9419212320 | ||||||||
| Practice Location | |||||||||
| Address1: | 3663 BEE RIDGE RD | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342331003 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9419248700 | ||||||||
| FaxNumber: | 9419212320 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 11/18/2011 | ||||||||
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| AuthorizedOfficialLastName: | PORTER | ||||||||
| AuthorizedOfficialFirstName: | ALAN | ||||||||
| AuthorizedOfficialMiddleName: | HARRY | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 9419248700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | DF1791 | 01 | R.R. MEDICARE | OTHER | 265210200 | 05 | FL | MEDICAID |