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General NPI Number Information
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NPI Number | 1124096060
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Entity Type | Individual
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Provider Name | BERTRAM A LEWIS JR. M.D., PH.D. MBA FACS
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Gender | Male
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Dates
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Enumeration Date | 03/08/2006
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Last Update Date | 03/17/2016
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Provider Practice Location Address
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Address Line | 6748 GALL BLVD
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City | ZEPHYRHILLS
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State | FL
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Zip | 33542-2544
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Country | US
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Telephone | 813-779-1209
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Fax | 813-779-1216
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Provider Business Mailing Address
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Address Line | 6748 GALL BLVD
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City | ZEPHYRHILLS
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State | FL
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Zip | 33542-2544
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Country | US
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Telephone | 813-779-1209
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Fax | 813-779-1216
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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 | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 9901570
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 35491
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License Number State | AZ
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Taxonomy #3
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | ME103274
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License Number State | FL
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