Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 4158 | AZ |
NPI | 1144453044 |
---|---|
Provider Name | Dr. Jeffrey D Lewis |
First Address | Tucson, AZ 85712-2764 |
Second Address | Tucson, AZ 85712-2764 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2009 |
Last Update Date | 26/08/2009 |