Provider Demographics
NPI:1790793164
Name:LEWIS, DWIGHT E JR (MD)
Entity Type:Individual
Prefix:
First Name:DWIGHT
Middle Name:E
Last Name:LEWIS
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1210 KY HIGHWAY 36 E
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:CYNTHIANA
Mailing Address - State:KY
Mailing Address - Zip Code:41031-7490
Mailing Address - Country:US
Mailing Address - Phone:859-234-1173
Mailing Address - Fax:859-234-1852
Practice Address - Street 1:1210 KY HIGHWAY 36 E
Practice Address - Street 2:SUITE 1B
Practice Address - City:CYNTHIANA
Practice Address - State:KY
Practice Address - Zip Code:41031-7490
Practice Address - Country:US
Practice Address - Phone:859-234-1173
Practice Address - Fax:859-234-1852
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-03
Last Update Date:2016-03-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY23897207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64238975Medicaid
KY64238975Medicaid
KY64238975Medicaid