Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 8091 | NH |
NPI | 1700869096 |
---|---|
Provider Name | Dr. David Brian Lewis |
First Address | Bedford, NH 03110-6750 |
Second Address | Bedford, NH 03110-6928 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/11/2005 |
Last Update Date | 25/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
80000190 | (05) | NH |