Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | PO3239 | FL |
N | 222Z00000X | Podiatrist | PO3239 | FL |
N | 213EP1101X | Primary Podiatric Medicine | PO3239 | FL |
N | 111NR0200X | Radiology | PO3239 | FL |
N | 213ER0200X | Radiology | PO3239 | FL |
N | 2081S0010X | Sports Medicine | PO3239 | FL |
N | 213ES0000X | Sports Medicine | PO3239 | FL |
Y | 213ES0103X | Foot & Ankle Surgery | PO3239 | FL |
NPI | 1871572206 |
---|---|
Provider Name | Dr. Gideon Jawaharlal Lewis |
First Address | Winter Park, FL 32789-2859 |
Second Address | Winter Park, FL 32789-2859 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2006 |
Last Update Date | 28/04/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
7530981 | CIGNA (01) | FL |
7581866 | AETNA (01) | FL |
P00423470 | RAILROAD MEDICARE (01) | FL |
PO3239 | LICENSE (01) | FL |
V10063 | (02) | FL |