# NORTH LITTLE ROCK PRIMARY CARE AND DIAGNOSTIC CLINIC PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1306877576
- **Authorized official:** DR. DEREK LEWIS MD (PRESIDENT)
- **Authorized official phone:** (501) 771-7717

## Contact information

- **Practice address:** 400 W PERSHING BLVD, N LITTLE ROCK, AR 72114-2146
- **Practice address phone:** (501) 771-7717
- **Practice address fax:** (501) 771-0550
- **Mailing address:** 400 W PERSHING BLVD, N LITTLE ROCK, AR 72114-2146
- **Mailing address phone:** (501) 771-7717
- **Mailing address fax:** (501) 771-0550

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 07/06/2006
- **Last updated:** 01/03/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 133705002 | — | AR |
| 01 | — | 5B979 | BLUE CROSS | AR |