Provider Demographics
NPI:1295363737
Name:PORTER, ASHTON JAE (MD)
Entity type:Individual
Prefix:DR
First Name:ASHTON
Middle Name:JAE
Last Name:PORTER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:11001 EXECUTIVE CENTER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-4393
Mailing Address - Country:US
Mailing Address - Phone:870-674-6335
Mailing Address - Fax:870-674-6892
Practice Address - Street 1:1703 N BUERKLE ST
Practice Address - Street 2:
Practice Address - City:STUTTGART
Practice Address - State:AR
Practice Address - Zip Code:72160-3153
Practice Address - Country:US
Practice Address - Phone:870-674-6335
Practice Address - Fax:870-674-6892
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-30
Last Update Date:2024-04-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARE-17943207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology