Provider Demographics
NPI:1518084995
Name:LEWIS, DAVID B (NCMMT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:B
Last Name:LEWIS
Suffix:
Gender:M
Credentials:NCMMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:952 BLOOMSBURY CV
Mailing Address - Street 2:
Mailing Address - City:MURRAY
Mailing Address - State:UT
Mailing Address - Zip Code:84123-7605
Mailing Address - Country:US
Mailing Address - Phone:801-261-1672
Mailing Address - Fax:
Practice Address - Street 1:6884 REDWOOD RD
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84084-2405
Practice Address - Country:US
Practice Address - Phone:801-495-4490
Practice Address - Fax:801-495-4493
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5567738-4701174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist