Healthcare Provider Details

I. General information

NPI: 1326319740
Provider Name (Legal Business Name): ALAN T. LEWIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2012
Last Update Date: 01/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4421 CHASTANT ST
METAIRIE LA
70006-2053
US

IV. Provider business mailing address

1245 42ND AVE
GULFPORT MS
39501-2666
US

V. Phone/Fax

Practice location:
  • Phone: 228-864-8049
  • Fax: 228-864-7655
Mailing address:
  • Phone: 228-864-8049
  • Fax: 228-864-7655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberMD14710R
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ALAN THOMAS LEWIS
Title or Position: MEDICAL DOCTOR
Credential: M.D.
Phone: 228-864-8049