Provider Demographics
NPI:1417553769
Name:LEWIS, STEVEN EDWARD JR
Entity Type:Individual
Prefix:MR
First Name:STEVEN
Middle Name:EDWARD
Last Name:LEWIS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14430 NS 3500 RD
Mailing Address - Street 2:
Mailing Address - City:KONAWA
Mailing Address - State:OK
Mailing Address - Zip Code:74849
Mailing Address - Country:US
Mailing Address - Phone:580-925-2650
Mailing Address - Fax:833-402-9799
Practice Address - Street 1:14430 NS 3500 RD
Practice Address - Street 2:
Practice Address - City:KONAWA
Practice Address - State:OK
Practice Address - Zip Code:74849
Practice Address - Country:US
Practice Address - Phone:580-925-2650
Practice Address - Fax:833-402-9799
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist