Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | MD18920 | OR |
NPI | 1720061047 |
---|---|
Provider Name | David Warren Lewis |
First Address | Cheyenne, WY 82001-5356 |
Second Address | Cheyenne, WY 82001-5356 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2005 |
Last Update Date | 24/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8264426 | (05) | WA |