Provider Demographics
NPI:1508845116
Name:LEWIS, GIDEON GRIFFETH (MD)
Entity Type:Individual
Prefix:DR
First Name:GIDEON
Middle Name:GRIFFETH
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 1:650 N WYMORE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2859
Mailing Address - Country:US
Mailing Address - Phone:407-647-0199
Mailing Address - Fax:407-647-0213
Practice Address - Street 1:650 N WYMORE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2859
Practice Address - Country:US
Practice Address - Phone:407-647-0199
Practice Address - Fax:407-647-0213
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 29256207QA0000X, 207QA0505X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2403499008OtherCIGNA HEALTHCARE ID
FLME 29256OtherSTATE LICENSE
FL4311031OtherAETNA PPO/POS ID
FL59249OtherBCBS ID
FL064809400Medicaid
FL080137252OtherRAILROAD MEDICARE ID
FL2134653OtherAETNA HMO ID
FL080137252OtherRAILROAD MEDICARE ID
FLD57042Medicare UPIN