Provider Demographics
NPI:1235282260
Name:LEWIS, MAJORIE MARRIE (MD)
Entity Type:Individual
Prefix:MS
First Name:MAJORIE
Middle Name:MARRIE
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 1:1590 SW 139TH AVE
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33325-6000
Mailing Address - Country:US
Mailing Address - Phone:239-297-4127
Mailing Address - Fax:
Practice Address - Street 1:1590 SW 139TH AVE
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33325-6000
Practice Address - Country:US
Practice Address - Phone:239-297-4127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77483207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG95633Medicare UPIN
FL46450Medicare ID - Type Unspecified