Provider Demographics
NPI:1295779734
Name:LEWIS, TODD JAY (MD)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:JAY
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2211 NW PROFESSIONAL DR
Mailing Address - Street 2:STE 100
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3887
Mailing Address - Country:US
Mailing Address - Phone:541-757-7463
Mailing Address - Fax:541-757-7465
Practice Address - Street 1:2211 NW PROFESSIONAL DR
Practice Address - Street 2:STE 100
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3887
Practice Address - Country:US
Practice Address - Phone:541-757-7463
Practice Address - Fax:541-757-7465
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2008-02-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORMD13887207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR5654060001Medicare NSC
ORC93149Medicare UPIN