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1376531871 NPI number — JEFFREY D. LEWIS MD

NPI Number: 1376531871
Health Care Provider/Practitioner: JEFFREY D. LEWIS MD

Information about “1376531871” NPI (JEFFREY D. LEWIS MD) exists in 1376531871 in HTML format HTML  |  1376531871 in plain Text format TXT  |  1376531871 in PDF (Portable Document Format) PDF  |  1376531871 in an XML format XML  formats.

NPI Number : 1376531871 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1376531871",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "LEWIS",
    "FirstName": "JEFFREY",
    "MiddleName": "D.",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "400 E 3RD ST",
    "SecondLineMailingAddress": "ESSENTIA HEALTH DULUTH CLINIC",
    "MailingAddressCityName": "DULUTH",
    "MailingAddressStateName": "MN",
    "MailingAddressPostalCode": "55805-1951",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "218-786-3317",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "400 E 3RD ST",
    "SecondLinePracticeLocationAddress": "ESSENTIA HEALTH DULUTH CLINIC",
    "PracticeLocationAddressCityName": "DULUTH",
    "PracticeLocationAddressStateName": "MN",
    "PracticeLocationAddressPostalCode": "55805-1951",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "218-786-3317",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "10/10/2005",
    "LastUpdateDate": "09/28/2016",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": "12/15/2005",
    "NPIReactivationDate": "07/25/2006",
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "36348-020",
          "LicenseNumberStateCode": "WI",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207Q00000X",
          "TaxonomyName": "Family Medicine Physician",
          "LicenseNumber": "36348",
          "LicenseNumberStateCode": "WI",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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