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General NPI Number Information
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NPI Number | 1508845116
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Entity Type | Individual
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Provider Name | GIDEON GRIFFETH LEWIS M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/12/2006
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Last Update Date | 04/28/2008
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Provider Practice Location Address
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Address Line | 650 N WYMORE RD SUITE 202
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City | WINTER PARK
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State | FL
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Zip | 32789-2859
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Country | US
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Telephone | 407-647-0199
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Fax | 407-647-0213
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Provider Business Mailing Address
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Address Line | 650 N WYMORE RD SUITE 202
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City | WINTER PARK
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State | FL
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Zip | 32789-2859
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Country | US
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Telephone | 407-647-0199
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Fax | 407-647-0213
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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 | 207QA0000X
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Taxonomy Name | Adolescent Medicine (Family Medicine) Physician
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License Number | ME 29256
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | ME 29256
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | ME 29256
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License Number State | FL
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