Healthcare Provider Details

I. General information

NPI: 1366406167
Provider Name (Legal Business Name): CHRISTOPHER YOUNG LEW M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 11/06/2020
Certification Date: 11/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 GAUSE BLVD E SUITE 201
SLIDELL LA
70461-5442
US

IV. Provider business mailing address

1113 CRYSTAL CT
SLIDELL LA
70461-5093
US

V. Phone/Fax

Practice location:
  • Phone: 985-649-5825
  • Fax: 985-645-0884
Mailing address:
  • Phone: 985-639-8265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number14529
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberMD.10231R
License Number StateLA
# 3
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number10231R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: