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General NPI Number Information
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NPI Number | 1497247811
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Entity Type | Individual
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Provider Name | STEPHEN DOUGLAS LEWIA JR. PA-C
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Gender | Male
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Dates
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Enumeration Date | 06/01/2018
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Last Update Date | 06/10/2021
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Provider Practice Location Address
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Address Line | 510 E CARTHAGE ST
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City | MEADE
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State | KS
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Zip | 67864-6401
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Country | US
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Telephone | 620-873-2112
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Fax | 620-873-5371
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Provider Business Mailing Address
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Address Line | 150 N MCLEAN BLVD APT 238
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City | WICHITA
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State | KS
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Zip | 67203-5940
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Country | US
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Telephone | 703-378-2382
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA55973
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0110-007212
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 15-02343
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License Number State | KS
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