Provider Demographics
NPI:1942206255
Name:LEWIS, PHILIP ALDEN JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:ALDEN
Last Name:LEWIS
Suffix:JR
Gender:M
Credentials:DPM
Other - Prefix:
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Mailing Address - Street 1:315 TWIN PONDS LN
Mailing Address - Street 2:
Mailing Address - City:VASS
Mailing Address - State:NC
Mailing Address - Zip Code:28394-9266
Mailing Address - Country:US
Mailing Address - Phone:901-822-7131
Mailing Address - Fax:910-822-7035
Practice Address - Street 1:2300 RAMSEY ST
Practice Address - Street 2:VA MEDICAL CENTER (112)
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-3856
Practice Address - Country:US
Practice Address - Phone:910-822-7131
Practice Address - Fax:910-822-7035
Is Sole Proprietor?:No
Enumeration Date:2005-06-22
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MEPOD 209213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery