MEDICARE: DR. RYAN L LEWIS 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	208600000X	Surgery Physician	14234	CO
2	208600000X	Surgery Physician	4933554-1204	UT

General Provider Information

NPI Number	:	1942290622
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN L LEWIS D.O.

Provider Business Mailing Address
First Line	:	1490 E FOREMASTER DR STE 200
Second Line	:
City	:	ST GEORGE
State	:	UT
Zip	:	84790-4496
Country	:	US
Telephone Number	:	435-628-1641
Fax Number	:	435-628-1660

Provider Business Practice Location Address
First Line	:	1490 E FOREMASTER DR STE 200
Second Line	:
City	:	SAINT GEORGE
State	:	UT
Zip	:	84790-4496
Country	:	US
Telephone Number	:	435-628-1641
Fax Number	:	435-628-1660

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

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	06/13/2013

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Directions to “ DR. RYAN L LEWIS D.O.” Practice Location

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