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General NPI Number Information
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NPI Number | 1326070962
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Entity Type | Individual
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Provider Name | MARTIN GWENT LEWIS M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/06/2006
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Last Update Date | 02/08/2012
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Provider Practice Location Address
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Address Line | 6501 PASADENA AVENUE, NORTH
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City | ST. PETERSBURG
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State | FL
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Zip | 33710
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Country | US
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Telephone | 727-343-3545
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Fax | 727-343-3681
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Provider Business Mailing Address
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Address Line | 6501 PASADENA AVENUE, NORTH
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City | ST. PETERSBURG
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State | FL
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Zip | 33710
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Country | US
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Telephone | 727-343-3545
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Fax | 727-343-3681
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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 | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | ME43645
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License Number State | FL
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