MEDICARE: DR. HEATHER LYNN 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	208600000X	Surgery Physician	DR.0058328	CO
2	2086X0206X	Surgical Oncology Physician	11084A	WY
3	390200000X	Student in an Organized Health Care Education/Training Program
4	2086X0206X	Surgical Oncology Physician	DR.0058328	CO

General Provider Information

NPI Number	:	1255593851
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HEATHER LYNN LEWIS M.D.

Provider Business Mailing Address
First Line	:	2121 E HARMONY ROAD
Second Line	:	SUITE 330
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-3403
Country	:	US
Telephone Number	:	970-221-5878
Fax Number	:	970-221-3564

Provider Business Practice Location Address
First Line	:	2121 E HARMONY RD UNIT 330
Second Line	:
City	:	FORT COLLINS
State	:	CO
Zip	:	80528-3403
Country	:	US
Telephone Number	:	970-221-5878
Fax Number	:	970-221-3564

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

Provider Enumeration Date	:	06/26/2008
Last Update Date	:	03/17/2018

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