Provider Demographics
NPI:1639173271
Name:LEWIS, CLIFTON THOMAS PANNELL (MD)
Entity Type:Individual
Prefix:
First Name:CLIFTON
Middle Name:THOMAS PANNELL
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 1:1900 UNIVERSITY BLVD
Mailing Address - Street 2:THT721
Mailing Address - City:BIRMINGHAM,
Mailing Address - State:AL
Mailing Address - Zip Code:35233
Mailing Address - Country:US
Mailing Address - Phone:205-934-3338
Mailing Address - Fax:205-934-2042
Practice Address - Street 1:2000 6TH AVE S FL 4
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35233-2110
Practice Address - Country:US
Practice Address - Phone:205-934-3338
Practice Address - Fax:205-934-2042
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME55952208G00000X
AL11515208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL062435700Medicaid
FL09926OtherBCBS PROVIDER #
FLP00031559OtherRAILROAD MEDICARE PROVIDE
FL062435700Medicaid
FL09926TMedicare ID - Type UnspecifiedPROVIDER #
AL510I780004Medicare PIN