Provider Demographics
NPI:1013044999
Name:LEWIS, WALTER J (MD)
Entity Type:Individual
Prefix:
First Name:WALTER
Middle Name:J
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:13943 N 91 AVENUE
Mailing Address - Street 2:C-101
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85381-3629
Mailing Address - Country:US
Mailing Address - Phone:623-760-9449
Mailing Address - Fax:623-974-9351
Practice Address - Street 1:14537 W INDIAN SCHOOL RD
Practice Address - Street 2:#700
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-9243
Practice Address - Country:US
Practice Address - Phone:623-935-0247
Practice Address - Fax:623-974-9351
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2013-10-04
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Provider Licenses
StateLicense IDTaxonomies
AZ40648207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ4Z2980OtherHEALTH NET
AZ608299OtherAHCCCS
AZ608299Medicaid
AZP00725809OtherRAILROAD MEDICARE
AZ1081859OtherUNITED HEALTHCARE
AZ608299OtherAETNA
AZ1013044999OtherBLUE CROSS BLUE SHIELD
AZ1013044999OtherTRICARE
AZ40648OtherSTATE LICENSE
AZ1013044999OtherTRICARE
AZ40648OtherSTATE LICENSE