Provider Demographics
NPI:1740260744
Name:LEWIS, LEON WRENSFORD (MD)
Entity type:Individual
Prefix:DR
First Name:LEON
Middle Name:WRENSFORD
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:420 LOWELL DR SE
Mailing Address - Street 2:401
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3754
Mailing Address - Country:US
Mailing Address - Phone:256-489-8845
Mailing Address - Fax:256-489-8849
Practice Address - Street 1:420 LOWELL DR SE
Practice Address - Street 2:401
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-3754
Practice Address - Country:US
Practice Address - Phone:256-489-8845
Practice Address - Fax:256-489-8849
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2012-03-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL21281207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009979225Medicaid
AL009979225Medicaid
ALG56845Medicare UPIN