Provider Demographics
NPI:1407883044
Name:PORTER, LEWIS E (MD)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:E
Last Name:PORTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1615
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72145-1615
Mailing Address - Country:US
Mailing Address - Phone:501-776-6093
Mailing Address - Fax:501-776-6019
Practice Address - Street 1:5 MEDICAL PARK DR
Practice Address - Street 2:SUITE GL2
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3729
Practice Address - Country:US
Practice Address - Phone:501-778-4862
Practice Address - Fax:501-778-4685
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE5015208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1407883044OtherBCBS
AR164093001Medicaid
AR1407883044OtherBCBS
G42781Medicare UPIN