Provider Demographics
NPI:1235128430
Name:LEWIS, ELIZABETH GAIL (MD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:GAIL
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 1:2701 SW CORNELL AVE
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-7121
Mailing Address - Country:US
Mailing Address - Phone:580-248-0696
Mailing Address - Fax:580-357-7589
Practice Address - Street 1:2701 SW CORNELL AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-7121
Practice Address - Country:US
Practice Address - Phone:580-248-0696
Practice Address - Fax:580-357-7589
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK54372080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine