Provider Demographics
NPI:1588621940
Name:LEWIS, JUDITH ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:ANN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JUDITH
Other - Middle Name:
Other - Last Name:COREY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1260 METROPOLITAN BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32312-2557
Mailing Address - Country:US
Mailing Address - Phone:850-216-0100
Mailing Address - Fax:850-201-4818
Practice Address - Street 1:1260 METROPOLITAN BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32312-2557
Practice Address - Country:US
Practice Address - Phone:850-216-0100
Practice Address - Fax:850-201-4818
Is Sole Proprietor?:No
Enumeration Date:2006-04-28
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 77772207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL46459VMedicare PIN
E97710Medicare UPIN