MEDICARE: RALPH CARL 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	207V00000X	Obstetrics & Gynecology Physician	MD13673	OR

General Provider Information

NPI Number	:	1710948351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RALPH CARL LEWIS M.D.

Provider Business Mailing Address
First Line	:	5125 SKYLINE RD S
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97306-9427
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5125 SKYLINE RD S
Second Line	:
City	:	SALEM
State	:	OR
Zip	:	97306-9427
Country	:	US
Telephone Number	:	503-370-4868
Fax Number	:

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

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	07/16/2007

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