Provider Demographics
NPI:1922217181
Name:LEWIS, JOHN HARRISON (OTR)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:HARRISON
Last Name:LEWIS
Suffix:
Gender:M
Credentials:OTR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8050 NIWOT RD
Mailing Address - Street 2:#32
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80503-8639
Mailing Address - Country:US
Mailing Address - Phone:303-652-0524
Mailing Address - Fax:
Practice Address - Street 1:311 MAPLETON AVE
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80304-3979
Practice Address - Country:US
Practice Address - Phone:303-441-0447
Practice Address - Fax:303-441-0536
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist