Provider Demographics
NPI:1770686198
Name:LEWIS, JACQUELINE BELINDA (MD)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:BELINDA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:801 PRINCETON AVE SW
Mailing Address - Street 2:PROFESSIONAL OFFICE BLDG I STE 108
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35211
Mailing Address - Country:US
Mailing Address - Phone:205-780-6090
Mailing Address - Fax:205-780-3060
Practice Address - Street 1:801 PRINCETON AVE SW
Practice Address - Street 2:PROFESSIONAL OFFICE BLDG I STE 108
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35211
Practice Address - Country:US
Practice Address - Phone:205-780-6090
Practice Address - Fax:205-780-3060
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2012-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11827208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000089750Medicaid
E20815Medicare UPIN
AL000089750Medicare ID - Type Unspecified