Provider Demographics
NPI:1982637831
Name:LEWIS, ADAM I (MD)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:I
Last Name:LEWIS
Suffix:
Gender:M
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:PO BOX 600366
Mailing Address - Street 2:
Mailing Address - City:ST JOHNS
Mailing Address - State:FL
Mailing Address - Zip Code:32260-0366
Mailing Address - Country:US
Mailing Address - Phone:904-717-9625
Mailing Address - Fax:904-683-6499
Practice Address - Street 1:3750 SAN JOSE PL STE 35
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257-8861
Practice Address - Country:US
Practice Address - Phone:904-717-9625
Practice Address - Fax:904-683-6499
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS14878174400000X
TXU7124207T00000X
FLME125571207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0120069Medicaid
MS140000117Medicare ID - Type Unspecified
G28405Medicare UPIN