Provider Demographics
NPI:1043234040
Name:LEWIS, CANDICE NELSON (MD)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:NELSON
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:CANDICE
Other - Middle Name:LYNN
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 910221
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-0221
Mailing Address - Country:US
Mailing Address - Phone:520-519-7700
Mailing Address - Fax:
Practice Address - Street 1:1845 W. ORANGE GROVE
Practice Address - Street 2:BUILDING 2
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704
Practice Address - Country:US
Practice Address - Phone:520-531-8967
Practice Address - Fax:520-742-7180
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35595174400000X, 207VX0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ111737Medicaid
AZ111737Medicaid
AZZ110502Medicare PIN
AZ111737Medicaid