Healthcare Provider Details

I. General information

NPI: 1346397304
Provider Name (Legal Business Name): DAVID OWEN LEWIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2007
Last Update Date: 05/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18688 JEB STUART HWY
STUART VA
24171-1559
US

IV. Provider business mailing address

828 TURNER ASHBY RD
MARTINSVILLE VA
24112-0647
US

V. Phone/Fax

Practice location:
  • Phone: 276-694-8655
  • Fax:
Mailing address:
  • Phone: 276-632-8549
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101023990
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: