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NPI Code Detail

MEDICARE: DAVID WARREN LEWIS MD PHD

MEDICARE: DAVID WARREN LEWIS MD PHD
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
1207U00000XNuclear Medicine PhysicianMD18920OR
22085R0202XDiagnostic Radiology PhysicianMD00049252WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1720061047
Entity Type Code : Individual
Provider Name (Legal Business Name) : DAVID WARREN LEWIS MD PHD
Provider Business Mailing Address
First Line : 2360 E PERSHING BLVD
Second Line :
City : CHEYENNE
State : WY
Zip : 82001-5356
Country : US
Telephone Number : 307-778-7550
Fax Number : 307-778-7510
Provider Business Practice Location Address
First Line : 2360 E PERSHING BLVD
Second Line :
City : CHEYENNE
State : WY
Zip : 82001-5356
Country : US
Telephone Number : 307-778-7550
Fax Number : 307-778-7510
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2005
Last Update Date : 01/24/2020

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