Provider Demographics
NPI:1457362287
Name:LEWIS, JANET I (MD)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:I
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6034
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-0034
Mailing Address - Country:US
Mailing Address - Phone:850-384-3151
Mailing Address - Fax:850-744-9060
Practice Address - Street 1:4225 WOODBINE RD STE C
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-8791
Practice Address - Country:US
Practice Address - Phone:850-384-3151
Practice Address - Fax:850-474-9060
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73254207PE0005X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2559919-00Medicaid
FL42309Medicare PIN
FLG22250Medicare UPIN