Provider Demographics
NPI:1346432226
Name:SEWELL, LINDSAY D (MD)
Entity Type:Individual
Prefix:DR
First Name:LINDSAY
Middle Name:D
Last Name:SEWELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2085 PROVIDENCE WAY
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-4945
Mailing Address - Country:US
Mailing Address - Phone:208-525-4888
Mailing Address - Fax:208-525-4885
Practice Address - Street 1:2085 PROVIDENCE WAY
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-4945
Practice Address - Country:US
Practice Address - Phone:208-525-4888
Practice Address - Fax:208-525-4885
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2009-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM10198207ND0101X, 207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology