Provider Demographics
NPI:1376516955
Name:LEWIS, RICHARD J (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:J
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:PO BOX 63423
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85082-3423
Mailing Address - Country:US
Mailing Address - Phone:480-892-2800
Mailing Address - Fax:480-982-1400
Practice Address - Street 1:4838 E BASELINE RD
Practice Address - Street 2:BLDG. 2 STE. 110
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4671
Practice Address - Country:US
Practice Address - Phone:480-892-2800
Practice Address - Fax:480-892-3258
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ35079207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ035451Medicaid
AZZ108492Medicare PIN
AZ035451Medicaid
AZZ108491Medicare PIN
AZZ108493Medicare PIN
AZP00297423Medicare PIN