Healthcare Provider Details

I. General information

NPI: 1639589302
Provider Name (Legal Business Name): WESLEY KREIG LEWIS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2014
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

740 N SAN MARCOS DR
APACHE JUNCTION AZ
85120-5518
US

IV. Provider business mailing address

740 N SAN MARCOS DR
APACHE JUNCTION AZ
85120-5518
US

V. Phone/Fax

Practice location:
  • Phone: 480-597-1751
  • Fax: 480-360-6591
Mailing address:
  • Phone: 480-597-1751
  • Fax: 480-360-6591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number980
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberT-1448
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number866
License Number StateAZ
# 4
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPOD-000980
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: