Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | 00027609 | AL |
NPI | 1003801473 |
---|---|
Provider Name | David Sidney Lewis |
First Address | Anniston, AL 36207-5846 |
Second Address | Anniston, AL 36207-5709 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2005 |
Last Update Date | 30/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
009939813 | (05) | AL |
510-04377 | BCBSAL (01) | AL |
H97523 | (02) |