Provider Demographics
NPI:1932186491
Name:LEWIS, DOROTHY A (M D)
Entity Type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:A
Last Name:LEWIS
Suffix:
Gender:F
Credentials:M D
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 3087
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70404-3087
Mailing Address - Country:US
Mailing Address - Phone:985-230-3668
Mailing Address - Fax:985-370-7409
Practice Address - Street 1:15770 PAUL VEGA MD DR STE 108B
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1475
Practice Address - Country:US
Practice Address - Phone:985-230-7430
Practice Address - Fax:985-230-7431
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA021262208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1933767Medicaid
LA$$$$$$$$$AOtherBLUE CROSS BLUE SHIELD
5R089DF06Medicare PIN
LAF33016Medicare UPIN