Provider Demographics
NPI:1851318364
Name:LEWIS, COLLINS E (MD)
Entity Type:Individual
Prefix:DR
First Name:COLLINS
Middle Name:E
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8134
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-286-1700
Mailing Address - Fax:314-286-1777
Practice Address - Street 1:24 S KINGSHIGHWAY BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63108-1301
Practice Address - Country:US
Practice Address - Phone:314-286-1700
Practice Address - Fax:314-286-1777
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR46922084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO200553808Medicaid
IL$$$$$$$$$Medicaid
MO011010213Medicare PIN