Provider Demographics
NPI:1164693446
Name:PETER A LEWIS INTERNAL MEDICINE PLUS, PL
Entity Type:Organization
Organization Name:PETER A LEWIS INTERNAL MEDICINE PLUS, PL
Other - Org Name:INTERNAL MEDICINE PLUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:ADOLPHUS
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-274-0200
Mailing Address - Street 1:5172 MASON CORBIN CT
Mailing Address - Street 2:SUITE 3
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-4540
Mailing Address - Country:US
Mailing Address - Phone:237-274-0200
Mailing Address - Fax:239-275-0229
Practice Address - Street 1:5172 MASON CORBIN CT
Practice Address - Street 2:SUITE 3
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-4540
Practice Address - Country:US
Practice Address - Phone:237-274-0200
Practice Address - Fax:239-275-0229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-14
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82915207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL13562OtherBLUE CROSS BLUE SHIELD OF
FL13562OtherBLUE CROSS BLUE SHIELD OF