Basic Information
| Provider Information | |||||||||
| NPI: | 1407883044 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PORTER | ||||||||
| FirstName: | LEWIS | ||||||||
| MiddleName: | E | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1615 | ||||||||
| Address2: | |||||||||
| City: | SEARCY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721451615 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5017766093 | ||||||||
| FaxNumber: | 5017766019 | ||||||||
| Practice Location | |||||||||
| Address1: | 5 MEDICAL PARK DR | ||||||||
| Address2: | SUITE GL2 | ||||||||
| City: | BENTON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720153729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5017784862 | ||||||||
| FaxNumber: | 5017784685 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2006 | ||||||||
| LastUpdateDate: | 06/23/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | E5015 | AR | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 1407883044 | 01 | AR | BCBS | OTHER | 164093001 | 05 | AR | MEDICAID |