Healthcare Provider Details

I. General information

NPI: 1457445579
Provider Name (Legal Business Name): ERNEST C LEWIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 12/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2115 S FREMONT AVE SUITE 1000
SPRINGFIELD MO
65804-2239
US

IV. Provider business mailing address

PO BOX 13453
GREEN BAY WI
54307-3453
US

V. Phone/Fax

Practice location:
  • Phone: 417-820-8099
  • Fax: 417-820-8093
Mailing address:
  • Phone: 920-432-6049
  • Fax: 920-884-3271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number46104
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number4301082745
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number2008020485
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: