Provider Demographics
NPI:1083947113
Name:LEWMAN, LARRY VICTOR (MD)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:VICTOR
Last Name:LEWMAN
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 1:13309 SE 84TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015-6922
Mailing Address - Country:US
Mailing Address - Phone:971-673-8218
Mailing Address - Fax:971-673-8321
Practice Address - Street 1:13309 SE 84TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-6922
Practice Address - Country:US
Practice Address - Phone:971-673-8218
Practice Address - Fax:971-673-8321
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-08
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA34470207ZF0201X
OR7776207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology
No207ZF0201XAllopathic & Osteopathic PhysiciansPathologyForensic Pathology