Provider Demographics
NPI:1184657876
Name:NEACE, LEWIS D (DO)
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:D
Last Name:NEACE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1012 SOUTH THIRD STREET
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:WA
Mailing Address - Zip Code:99328
Mailing Address - Country:US
Mailing Address - Phone:509-382-2531
Mailing Address - Fax:509-382-3205
Practice Address - Street 1:1012 SOUTH THIRD STREET
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:WA
Practice Address - Zip Code:99328
Practice Address - Country:US
Practice Address - Phone:509-382-2531
Practice Address - Fax:509-382-3205
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2015-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00000734207P00000X, 2083A0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
UAD000Medicare UPIN