REX PORTE, MD - NPI NUMBER 1801235783

Summary

Provider Name: REX PORTE, MD

NPI Number: 1801235783

Clasification: Student in an Organized Health Care Education/Training Program (390200000X)

Address:
1125 N COLLEGE AVE
FAYETTEVILLE, AR
ZIP 72703

Phone Number: (479) 713-8107



Detailed Information

Rex Porte, MD is a student in an organized health care education/training program in Fayetteville, AR. The provider is an individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. The assigned NPI number for this provider is 1801235783 and is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business address is:

1125 N COLLEGE AVE
FAYETTEVILLE, AR
ZIP 72703-908
Phone: (479) 713-8107

The enumeration date for this NPI number is 6/24/2013 and was last updated on 6/24/2013.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 390200000X Student in an Organized Health Care Education/Training Program Yes

NPI Record

No. Field Name Field Value
1 NPI 1801235783
2 Entity Type Code 1
3 Provider Last Name Legal Name PORTE
4 Provider First Name REX
5 Provider Credential Text MD
6 Provider First Line Business Practice Location Address 1125 N COLLEGE AVE
7 Provider Business Practice Location Address City Name FAYETTEVILLE
8 Provider Business Practice Location Address State Name AR
9 Provider Business Practice Location Address Postal Code 727031908
10 Provider Business Practice Location Address Country Code If outside U S US
11 Provider Business Practice Location Address Telephone Number 4797138107
12 Provider Enumeration Date 6/24/2013
13 Last Update Date 6/24/2013
14 Provider Gender Code M
15 Healthcare Provider Taxonomy Code 1 390200000X
16 Healthcare Provider Primary Taxonomy Switch 1 Y
17 Is Sole Proprietor Y

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This page was last updated on: 3/11/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.