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 1:5907 BERRYHILL RD
Mailing Address - Street 2:
Mailing Address - City:MILTON
Mailing Address - State:FL
Mailing Address - Zip Code:32570-8278
Mailing Address - Country:US
Mailing Address - Phone:850-623-9787
Mailing Address - Fax:850-626-7512
Practice Address - Street 1:5907 BERRYHILL RD
Practice Address - Street 2:
Practice Address - City:MILTON
Practice Address - State:FL
Practice Address - Zip Code:32570-8278
Practice Address - Country:US
Practice Address - Phone:850-623-9787
Practice Address - Fax:850-626-7512
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME73254207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2559919-00Medicaid
FL42309Medicare PIN
FLG22250Medicare UPIN