Provider Demographics
NPI:1235271495
Name:LEWIS, TIMOTHY LEE (PA-C)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:LEE
Last Name:LEWIS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8120 SHERIDAN BLVD
Mailing Address - Street 2:A-304
Mailing Address - City:WESMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80003-6100
Mailing Address - Country:US
Mailing Address - Phone:303-427-5302
Mailing Address - Fax:720-475-1830
Practice Address - Street 1:8120 SHERIDAN BLVD
Practice Address - Street 2:A-304
Practice Address - City:WESMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80003-6100
Practice Address - Country:US
Practice Address - Phone:303-427-5302
Practice Address - Fax:720-475-1830
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO102363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO201448Medicare ID - Type UnspecifiedPA
COR96637Medicare UPIN
CO341990Medicare Oscar/Certification