Provider Demographics
NPI:1205806510
Name:FIELDS, LEWIS BRADLEY (MD)
Entity type:Individual
Prefix:
First Name:LEWIS
Middle Name:BRADLEY
Last Name:FIELDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:BRAD
Other - Middle Name:
Other - Last Name:FIELDS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:800 S CHURCH ST
Mailing Address - Street 2:SUITE 302
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-4176
Mailing Address - Country:US
Mailing Address - Phone:870-935-3990
Mailing Address - Fax:870-935-0871
Practice Address - Street 1:800 S CHURCH ST
Practice Address - Street 2:SUITE 302
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-4176
Practice Address - Country:US
Practice Address - Phone:870-935-3990
Practice Address - Fax:870-935-0871
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN6969207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
9813669OtherCIGNA
AR12878000040OtherQUALCHOICE
AR770138201OtherEDS BREASTCARE
AS0140035OtherHUMANA TRICARE
AR54057OtherBLUE CROSS
AR160028625OtherMEDICARE RAILROAD COARRIE
AR111703001Medicaid
AR770138201OtherEDS BREASTCARE
540576911Medicare PIN