Healthcare Provider Details

I. General information

NPI: 1295721603
Provider Name (Legal Business Name): PAUL E LEWIS III MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 02/06/2023
Certification Date: 02/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7321 BALMER ST BLDG 570
HILL AFB UT
84056-5012
US

IV. Provider business mailing address

1835 N BEECHWOOD DR
LAYTON UT
84040-2211
US

V. Phone/Fax

Practice location:
  • Phone: 801-777-1163
  • Fax:
Mailing address:
  • Phone: 301-686-4856
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD83391
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberD83391
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: