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General NPI Number Information
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NPI Number | 1790793164
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Entity Type | Individual
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Provider Name | DWIGHT E LEWIS JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 03/02/2016
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Provider Practice Location Address
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Address Line | 1210 KY HIGHWAY 36 E SUITE 1B
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City | CYNTHIANA
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State | KY
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Zip | 41031-7490
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Country | US
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Telephone | 859-234-1173
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Fax | 859-234-1852
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Provider Business Mailing Address
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Address Line | 1210 KY HIGHWAY 36 E SUITE 1B
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City | CYNTHIANA
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State | KY
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Zip | 41031-7490
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Country | US
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Telephone | 859-234-1173
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Fax | 859-234-1852
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 23897
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License Number State | KY
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