Healthcare Provider Details

I. General information

NPI: 1639173271
Provider Name (Legal Business Name): CLIFTON THOMAS PANNELL LEWIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 04/21/2023
Certification Date: 03/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 6TH AVE S FL 4
BIRMINGHAM AL
35233-2110
US

IV. Provider business mailing address

1900 UNIVERSITY BLVD THT721
BIRMINGHAM AL
35233
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-3338
  • Fax: 205-934-2042
Mailing address:
  • Phone: 205-934-3338
  • Fax: 205-934-2042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberME55952
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number11515
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: