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Individual

REVEL DEAN PORTER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
300 CARSON ST, JONESBORO, AR 72401-3104
(870) 932-1198
(870) 910-7700
Mailing address
300 CARSON ST, JONESBORO, AR 72401-3104
(870) 932-1198
(870) 910-7700

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
R3338
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
101848001
AR
Enumeration date
09/21/2005
Last updated
05/27/2008
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