Provider Demographics
NPI:1043229990
Name:LEWIS, ERIC VAN (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:VAN
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4381 S EASON BLVD
Mailing Address - Street 2:SUITE 303
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38801-6583
Mailing Address - Country:US
Mailing Address - Phone:662-840-5747
Mailing Address - Fax:662-840-5856
Practice Address - Street 1:499 GLOSTER CREEK VLG STE G1
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4751
Practice Address - Country:US
Practice Address - Phone:662-377-2663
Practice Address - Fax:662-840-5856
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS20824207XS0106X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS07451813Medicaid
MS302I201040Medicare PIN