Healthcare Provider Details

I. General information

NPI: 1508845116
Provider Name (Legal Business Name): GIDEON GRIFFETH LEWIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 N WYMORE RD SUITE 202
WINTER PARK FL
32789-2859
US

IV. Provider business mailing address

650 N WYMORE RD SUITE 202
WINTER PARK FL
32789-2859
US

V. Phone/Fax

Practice location:
  • Phone: 407-647-0199
  • Fax: 407-647-0213
Mailing address:
  • Phone: 407-647-0199
  • Fax: 407-647-0213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License NumberME 29256
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberME 29256
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberME 29256
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: