Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | N8172 | AR |
NPI | 1588639512 |
---|---|
Provider Name | Dr. David Lewis |
First Address | Jonesboro, AR 72401-3145 |
Second Address | Jonesboro, AR 72401-3145 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 23/01/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
040004707 | RAILROAD MEDICARE (01) | AR |
120707001 | (05) | AR |
55085 | BCBS OF AR (01) | AR |
C78458 | (02) | AR |