MEDICARE: DR. JUDITH ANN 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	207R00000X	Internal Medicine Physician	ME 77772	FL

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	:	1588621940
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDITH ANN LEWIS M.D.

Provider Business Mailing Address
First Line	:	1260 METROPOLITAN BLVD
Second Line	:	SUITE 301
City	:	TALLAHASSEE
State	:	FL
Zip	:	32312-2557
Country	:	US
Telephone Number	:	850-216-0100
Fax Number	:	850-201-4818

Provider Business Practice Location Address
First Line	:	1260 METROPOLITAN BLVD
Second Line	:	SUITE 301
City	:	TALLAHASSEE
State	:	FL
Zip	:	32312-2557
Country	:	US
Telephone Number	:	850-216-0100
Fax Number	:	850-201-4818

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

Provider Enumeration Date	:	04/28/2006
Last Update Date	:	07/09/2015

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