Healthcare Provider Details

I. General information

NPI: 1912326901
Provider Name (Legal Business Name): JEFFREY D LEWIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2014
Last Update Date: 02/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5495 ARAPAHOE AVE FL 2
BOULDER CO
80303-1260
US

IV. Provider business mailing address

PO BOX 110429
AURORA CO
80042-0429
US

V. Phone/Fax

Practice location:
  • Phone: 720-848-9200
  • Fax: 720-848-9202
Mailing address:
  • Phone: 303-493-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR.0056054
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: