Provider Demographics
NPI:1912961301
Name:JEFFREY W LEWIS MD PA
Entity Type:Organization
Organization Name:JEFFREY W LEWIS MD PA
Other - Org Name:LEWIS & KNIGHT MD PA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:W
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-278-5200
Mailing Address - Street 1:16400 HEALTHPARK COMMONS DRIVE
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-9621
Mailing Address - Country:US
Mailing Address - Phone:239-278-5200
Mailing Address - Fax:239-278-4243
Practice Address - Street 1:16400 HEALTHPARK COMMONS DRIVE
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-9621
Practice Address - Country:US
Practice Address - Phone:239-278-5200
Practice Address - Fax:239-278-4243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-13
Last Update Date:2012-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53401208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL07160OtherBCBS
FL049245100Medicaid
FLA003OtherTRICARE
FL020011787OtherRAILROAD MEDICARE
FL24176Medicare ID - Type UnspecifiedGROUP ID
C65993Medicare UPIN
FL07160YMedicare ID - Type Unspecified