Healthcare Provider Details

I. General information

NPI: 1629364534
Provider Name (Legal Business Name): CLAYTON LEWIS M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2011
Last Update Date: 05/20/2024
Certification Date: 05/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 N NEVADA AVE STE 5017
COLORADO SPRINGS CO
80907-6865
US

IV. Provider business mailing address

1650 COCHRANE CIR UNIT MEDDAC
FORT CARSON CO
80913-4604
US

V. Phone/Fax

Practice location:
  • Phone: 719-776-6810
  • Fax: 719-776-6820
Mailing address:
  • Phone: 719-524-4166
  • Fax: 719-524-4183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberDR.0059462
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number01072163A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: