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General NPI Number Information
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NPI Number | 1215964309
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Entity Type | Individual
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Provider Name | RANDAL JOHN LEWIS M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/26/2006
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Last Update Date | 08/02/2020
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Provider Practice Location Address
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Address Line | 310 E 4500 S STE 410
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City | MURRAY
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State | UT
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Zip | 84107-3993
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Country | US
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Telephone | 801-850-2800
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Fax |
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Provider Business Mailing Address
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Address Line | 1082 N 1000 W
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City | AMERICAN FORK
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State | UT
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Zip | 84003-3897
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Country | US
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Telephone | 801-850-2800
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Fax |
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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 | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | 89-246
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 6901924-1205
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License Number State | UT
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