Provider Demographics
NPI:1780681205
Name:LEWIS, ROBERT (CRNA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:LEWIS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5141 S GILA AVE
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85746-9526
Mailing Address - Country:US
Mailing Address - Phone:928-812-0497
Mailing Address - Fax:520-883-3420
Practice Address - Street 1:5141 S GILA AVE
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85746-9526
Practice Address - Country:US
Practice Address - Phone:928-812-0497
Practice Address - Fax:520-883-3420
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN038861367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z83686Medicare PIN
AZZ145888Medicare PIN
AZZ150733Medicare PIN
AZR10171Medicare UPIN
AZZRNA33213EMedicare PIN