Healthcare Provider Details

I. General information

NPI: 1861552960
Provider Name (Legal Business Name): MEGAN EWING-LEWIS GROTEFEND MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN EWING LEWIS M.D.

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4820 E MAIN ST
FARMINGTON NM
87402
US

IV. Provider business mailing address

PO BOX 844088
DALLAS TX
75284-4088
US

V. Phone/Fax

Practice location:
  • Phone: 505-609-6495
  • Fax: 505-324-0504
Mailing address:
  • Phone: 505-609-2258
  • Fax: 505-609-2259

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number42313
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number98-315
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: