MEDICARE: DR. CHARLES ALAN LEWIS M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2083P0901X	Public Health & General Preventive Medicine Physician	ME0057039	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080157777	OTHER	FL	RAILROAD (MEDICARE)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063432045
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES ALAN LEWIS M.D.

Provider Business Mailing Address
First Line	:	602 RIVERVIEW DR
Second Line	:
City	:	CARRABELLE
State	:	FL
Zip	:	32322-5053
Country	:	US
Telephone Number	:	850-697-4436
Fax Number	:

Provider Business Practice Location Address
First Line	:	1224 OCALA RD
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32304-1548
Country	:	US
Telephone Number	:	850-576-2129
Fax Number	:	850-576-9602

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	07/26/2015

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