=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366451221
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PETER ADOLPHUS LEWIS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/07/2006
-----------------------------------------------------
Last Update Date | 06/28/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5554 CLARCONA OCOEE RD
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32810-4056
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-292-0292
-----------------------------------------------------
Fax | 407-292-5175
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6416 OLD WINTER GARDEN RD
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32835-1348
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-751-7288
-----------------------------------------------------
Fax | 407-770-0661
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | ME82915
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------