Provider Demographics
NPI:1881642452
Name:LEWIS, PHILIP (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5354 GULF DR
Mailing Address - Street 2:TRINITY PHYSICIANS, LLC
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-3920
Mailing Address - Country:US
Mailing Address - Phone:727-849-4711
Mailing Address - Fax:727-841-6690
Practice Address - Street 1:5354 GULF DR
Practice Address - Street 2:TRINITY PHYSICIANS, LLC
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-3920
Practice Address - Country:US
Practice Address - Phone:727-849-4711
Practice Address - Fax:727-841-6690
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2009-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME29730208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
D85907Medicare UPIN
51123Medicare ID - Type Unspecified