Healthcare Provider Details

I. General information

NPI: 1811097348
Provider Name (Legal Business Name): ROBERT LEE LEWIS II MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 12/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 HOSPITAL DR SUITE 1208
HURRICANE WV
25526-8706
US

IV. Provider business mailing address

1208 HOSPITAL DR
HURRICANE WV
25526-8708
US

V. Phone/Fax

Practice location:
  • Phone: 304-757-5455
  • Fax: 304-757-5467
Mailing address:
  • Phone: 304-757-5747
  • Fax: 304-757-5744

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0600X
TaxonomyClinical Neurophysiology Physician
License Number21243
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number21243
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: