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General NPI Number Information
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NPI Number | 1972633634
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Entity Type | Organization
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Legal Business Name | ZACHARY OB GYN SERVICES
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6180 MAIN ST SUITE A
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City | ZACHARY
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State | LA
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Zip | 70791-4069
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Country | US
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Telephone | 225-658-8868
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Fax | 225-658-8840
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Provider Business Mailing Address
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Address Line | 6180 MAIN ST SUITE A
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City | ZACHARY
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State | LA
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Zip | 70791-4069
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Country | US
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Telephone | 225-658-8868
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Fax | 225-658-8840
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. LYDIA DEE LEWIS
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Credential | MD
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Telephone | 225-658-8868
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 15313R
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License Number State | LA
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