Provider Demographics
NPI:1679737365
Name:DR LEWIS E PORTER PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:DR LEWIS E PORTER PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:PORTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-847-9687
Mailing Address - Street 1:PO BOX 648
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72018-0648
Mailing Address - Country:US
Mailing Address - Phone:501-574-7044
Mailing Address - Fax:501-574-7058
Practice Address - Street 1:23157 HIGHWAY I-30
Practice Address - Street 2:SUITE 200
Practice Address - City:BRYANT
Practice Address - State:AR
Practice Address - Zip Code:72022
Practice Address - Country:US
Practice Address - Phone:501-847-9687
Practice Address - Fax:501-847-9909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-11
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-5015208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty