Provider Demographics
NPI:1235195066
Name:LEWIS, JUDITH LEE (DO)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:LEE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7211 29TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-5851
Mailing Address - Country:US
Mailing Address - Phone:206-258-4580
Mailing Address - Fax:206-258-4581
Practice Address - Street 1:7211 29TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-5851
Practice Address - Country:US
Practice Address - Phone:206-258-4580
Practice Address - Fax:206-258-4581
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP 00001398204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
WALE9113OtherREGENCE BLUE SHIELD
WA0032958OtherLABOR AND INDUSTRY
WA0032958OtherLABOR AND INDUSTRY