Provider Demographics
NPI:1396776522
Name:LEWIS, ANTHONY B (MD)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:B
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1391 NW SAINT LUCIE WEST BLVD # 216
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2196
Mailing Address - Country:US
Mailing Address - Phone:772-877-8578
Mailing Address - Fax:772-877-8549
Practice Address - Street 1:537 NW LAKE WHITNEY PL
Practice Address - Street 2:UNIT 103-106
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1620
Practice Address - Country:US
Practice Address - Phone:772-877-8578
Practice Address - Fax:772-398-6246
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2021-01-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME82977207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL01933VMedicare PIN
FLD69806Medicare UPIN
FLD69806Medicare UPIN
FL262203300Medicaid