Provider Demographics
NPI:1649509506
Name:LEWIS, WINSLOW III (PA)
Entity type:Individual
Prefix:MR
First Name:WINSLOW
Middle Name:
Last Name:LEWIS
Suffix:III
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 W ALDER ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4123
Mailing Address - Country:US
Mailing Address - Phone:406-258-4195
Mailing Address - Fax:406-258-4180
Practice Address - Street 1:323 W ALDER ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4123
Practice Address - Country:US
Practice Address - Phone:406-258-4195
Practice Address - Fax:406-258-4180
Is Sole Proprietor?:No
Enumeration Date:2009-12-23
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT592363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical