Provider Demographics
NPI:1659469245
Name:LEWIS, RICHARD B
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:B
Last Name:LEWIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4710 N HABANA AVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7161
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4710 N HABANA AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7161
Practice Address - Country:US
Practice Address - Phone:813-870-3850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 25776207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology