Active NPI
Jackson Leggett Porter, DDS
- Dentist
- Beaumont, TX
National Provider Identifier
1013066265
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 12315
- Practice address
- 4180 Delaware St
303
Beaumont, TX 77706-7858 - Phone
- (409) 899-2111
- Fax
- (409) 899-2821
- NPI assigned
- Jan 9, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 12315 | TX | Primary |
Addresses
Primary practice location
4180 Delaware St
303
Beaumont, TX 77706-7858
Mailing address
4180 Delaware
303
Beaumont, TX 77706
Phone (409) 899-2111
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150629002445 | TX | Order and Referring Only - Oral Surgery | 2466764766 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 12315 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1168300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1013066265",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4180 DELAWARE",
"address_2": "303",
"city": "BEAUMONT",
"state": "TX",
"postal_code": "77706",
"telephone_number": "409-899-2111",
"fax_number": "409-899-2821"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4180 DELAWARE ST",
"address_2": "303",
"city": "BEAUMONT",
"state": "TX",
"postal_code": "777067858",
"telephone_number": "409-899-2111",
"fax_number": "409-899-2821"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PORTER",
"first_name": "JACKSON",
"middle_name": "LEGGETT",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "12315",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Beaumont, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.