Provider Demographics
NPI:1851478085
Name:LEWIS, BRACKEN CLAY (MD)
Entity Type:Individual
Prefix:DR
First Name:BRACKEN
Middle Name:CLAY
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 23229
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42304-3229
Mailing Address - Country:US
Mailing Address - Phone:270-377-1950
Mailing Address - Fax:270-377-1953
Practice Address - Street 1:211 S CHERRY ST
Practice Address - Street 2:SUITE 2
Practice Address - City:GREENVILLE
Practice Address - State:KY
Practice Address - Zip Code:42345-1203
Practice Address - Country:US
Practice Address - Phone:270-377-1950
Practice Address - Fax:270-377-1953
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL29141207R00000X
KY43687207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100118210Medicaid
KYK091361Medicare PIN
KYK091360Medicare PIN