Healthcare Provider Details

I. General information

NPI: 1154369981
Provider Name (Legal Business Name): SAM W LEW MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2006
Last Update Date: 04/15/2022
Certification Date: 04/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E 32ND ST
SILVER CITY NM
88061-7287
US

IV. Provider business mailing address

1600 E 32ND ST
SILVER CITY NM
88061-7287
US

V. Phone/Fax

Practice location:
  • Phone: 575-538-2981
  • Fax: 855-653-5171
Mailing address:
  • Phone: 575-538-2981
  • Fax: 855-653-5171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number11137
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number13152
License Number StateME
# 3
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberMD2017-0771
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: