Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 5437 | OK |
NPI | 1235128430 |
---|---|
Provider Name | Dr. Elizabeth Gail Lewis |
First Address | Lawton, OK 73505-7121 |
Second Address | Lawton, OK 73505-7121 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/10/2005 |
Last Update Date | 08/07/2007 |