MEDICARE: MATTHEW WESLEY LEWIS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	23036	MS
2	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	23036	MS

General Provider Information

NPI Number	:	1003043506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW WESLEY LEWIS M.D.

Provider Business Mailing Address
First Line	:	6300 E LAKE BLVD
Second Line	:
City	:	VANCLEAVE
State	:	MS
Zip	:	39565-6770
Country	:	US
Telephone Number	:	228-206-2263
Fax Number	:	228-206-1192

Provider Business Practice Location Address
First Line	:	6300 E LAKE BLVD
Second Line	:	SUITE 201
City	:	VANCLEAVE
State	:	MS
Zip	:	39565-6770
Country	:	US
Telephone Number	:	228-206-2263
Fax Number	:	228-206-1192

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/11/2009
Last Update Date	:	03/22/2017

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