Provider Demographics
NPI:1235246265
Name:LEWIS, RICHARD H (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:H
Last Name:LEWIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4175 S CONGRESS AVE
Mailing Address - Street 2:SUITE D
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-4725
Mailing Address - Country:US
Mailing Address - Phone:561-968-8055
Mailing Address - Fax:561-968-4873
Practice Address - Street 1:4175 S CONGRESS AVE
Practice Address - Street 2:SUITE D
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-4725
Practice Address - Country:US
Practice Address - Phone:561-968-8055
Practice Address - Fax:561-968-4873
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-24
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO0002350213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL65-0474261Medicaid
FL65-0474261Medicaid
FL65303Medicare ID - Type Unspecified