Provider Demographics
NPI:1366451221
Name:LEWIS, PETER ADOLPHUS (MD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:ADOLPHUS
Last Name:LEWIS
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 1:6416 OLD WINTER GARDEN RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-1348
Mailing Address - Country:US
Mailing Address - Phone:407-751-7288
Mailing Address - Fax:407-770-0661
Practice Address - Street 1:5554 CLARCONA OCOEE RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-4056
Practice Address - Country:US
Practice Address - Phone:407-292-0292
Practice Address - Fax:407-292-5175
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME82915207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL13562OtherBLUE CROSS BLUE SHIELD
FL13562XOtherMEDICARE
FL0000218136505OtherUNITED HEALTHCARE
FL009575700Medicaid
FL13562XMedicare PIN
FL0000218136505OtherUNITED HEALTHCARE
FL0000218136505OtherUNITED HEALTHCARE