Individual
LEWIS GORDON PORTER IV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3 PROFESSIONAL PARK DR, SUITE 21, JOHNSON CITY, TN 37604-6529
(423) 434-6300
(423) 434-6312
Mailing address
3 PROFESSIONAL PARK DR, SUITE 21, JOHNSON CITY, TN 37604-6529
(864) 710-0745
(423) 434-6321
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1461
TN
Other
Enumeration date
12/08/2006
Last updated
03/27/2008
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