Healthcare Provider Details

I. General information

NPI: 1831585199
Provider Name (Legal Business Name): JOSEPH ROBERT LEWIS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13685 DOCTORS WAY STE 100
FORT MYERS FL
33912-4337
US

IV. Provider business mailing address

PO BOX 2147
FORT MYERS FL
33902-2147
US

V. Phone/Fax

Practice location:
  • Phone: 239-343-1612
  • Fax: 239-343-4229
Mailing address:
  • Phone: 239-343-1612
  • Fax: 239-343-4229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberOS17741
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number04741
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number6938
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberOS17741
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: