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General NPI Number Information
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NPI Number | 1013044999
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Entity Type | Individual
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Provider Name | WALTER J LEWIS M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 10/04/2013
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Provider Practice Location Address
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Address Line | 14537 W INDIAN SCHOOL RD #700
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City | GOODYEAR
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State | AZ
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Zip | 85395-9243
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Country | US
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Telephone | 623-935-0247
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Fax | 623-974-9351
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Provider Business Mailing Address
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Address Line | 13943 N 91 AVENUE C-101
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City | PEORIA
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State | AZ
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Zip | 85381-3629
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Country | US
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Telephone | 623-760-9449
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Fax | 623-974-9351
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 40648
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License Number State | AZ
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