MEDICARE: ALLEN LEWIS JR. D.O.

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	207R00000X	Internal Medicine Physician	18677	MS

Other Identifiers

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

General Provider Information

NPI Number	:	1134178841
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLEN LEWIS JR. D.O.

Provider Business Mailing Address
First Line	:	200 STATE HIGHWAY 30 W
Second Line	:
City	:	NEW ALBANY
State	:	MS
Zip	:	38652-3112
Country	:	US
Telephone Number	:	662-538-2425
Fax Number	:	662-538-2593

Provider Business Practice Location Address
First Line	:	200 STATE HIGHWAY 30 W
Second Line	:
City	:	NEW ALBANY
State	:	MS
Zip	:	38652-3112
Country	:	US
Telephone Number	:	662-538-2425
Fax Number	:	662-538-2593

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

Provider Enumeration Date	:	05/09/2006
Last Update Date	:	02/28/2008

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Directions to “ ALLEN LEWIS JR. D.O.” Practice Location

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