Provider Demographics
NPI:1477750115
Name:LEWIS, GUS JONATHAN (DO)
Entity Type:Individual
Prefix:DR
First Name:GUS
Middle Name:JONATHAN
Last Name:LEWIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:120 E 2ND ST FL 1
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16507-1537
Mailing Address - Country:US
Mailing Address - Phone:814-877-7072
Mailing Address - Fax:814-877-4897
Practice Address - Street 1:120 E 2ND ST FL 1
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16507-1537
Practice Address - Country:US
Practice Address - Phone:814-877-7072
Practice Address - Fax:814-877-4897
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY273317-01207RI0200X
PAOS015986207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease