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NPI Code Detail

MEDICARE: DR. JONKEETA ALICE LEWIS MD

MEDICARE: DR. JONKEETA ALICE LEWIS MD
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
1207Q00000XFamily Medicine Physician23417OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
223417OTHEROKLICENSE

General Provider Information

NPI Number : 1174687529
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JONKEETA ALICE LEWIS MD
Provider Business Mailing Address
First Line : 309 S ANN ARBOR AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73128-1112
Country : US
Telephone Number : 405-948-4900
Fax Number : 405-948-4933
Provider Business Practice Location Address
First Line : 309 S ANN ARBOR AVE
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73128-1112
Country : US
Telephone Number : 405-948-4900
Fax Number : 405-948-4933
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2006
Last Update Date : 01/18/2024

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