Provider Demographics
NPI:1982858916
Name:LEWIS, FREDERICK THOMAS (DO)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:THOMAS
Last Name:LEWIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1097 SMOKE TREE CT
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-2829
Mailing Address - Country:US
Mailing Address - Phone:954-389-8580
Mailing Address - Fax:919-654-8728
Practice Address - Street 1:1097 SMOKE TREE CT
Practice Address - Street 2:
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-2829
Practice Address - Country:US
Practice Address - Phone:954-389-8580
Practice Address - Fax:919-654-8728
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS-52802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry