MEDICARE: DR. WILLIE JAMES LEWIS SR. D.P.M.

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	213EP1101X	Primary Podiatric Medicine Podiatrist	80062	MS

General Provider Information

NPI Number	:	1972537041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIE JAMES LEWIS SR. D.P.M.

Provider Business Mailing Address
First Line	:	128 POINDEXTER ST
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39203-3048
Country	:	US
Telephone Number	:	601-355-0026
Fax Number	:	601-355-0069

Provider Business Practice Location Address
First Line	:	128 POINDEXTER ST
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39203-3048
Country	:	US
Telephone Number	:	601-355-0026
Fax Number	:	601-355-0069

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	07/08/2007

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