Provider Demographics
NPI:1407839525
Name:HARDEN, LEWIS BROWN (MD)
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:BROWN
Last Name:HARDEN
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:BUILDING 0221
Mailing Address - Street 2:
Mailing Address - City:CEDAR FALLS
Mailing Address - State:IA
Mailing Address - Zip Code:50614-0001
Mailing Address - Country:US
Mailing Address - Phone:319-273-2009
Mailing Address - Fax:319-273-7030
Practice Address - Street 1:BUILDING 0221
Practice Address - Street 2:
Practice Address - City:CEDAR FALLS
Practice Address - State:IA
Practice Address - Zip Code:50614-0001
Practice Address - Country:US
Practice Address - Phone:319-273-2009
Practice Address - Fax:319-273-7030
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA29150207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0154401Medicaid
IA170506OtherBLUE CROSS BLUE SHIELD
IAE04244Medicare UPIN