Provider Demographics
NPI:1225358575
Name:LEWIS, GALE WALKER (MD)
Entity Type:Individual
Prefix:
First Name:GALE
Middle Name:WALKER
Last Name:LEWIS
Suffix:
Gender:F
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:PO BOX 3360
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-3360
Mailing Address - Country:US
Mailing Address - Phone:866-366-2983
Mailing Address - Fax:
Practice Address - Street 1:1330 ROCKEFELLER AVE
Practice Address - Street 2:STE 210
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-1676
Practice Address - Country:US
Practice Address - Phone:425-261-4940
Practice Address - Fax:425-261-4932
Is Sole Proprietor?:No
Enumeration Date:2010-06-09
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 28921207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine