Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 0102201012 | VA |
NPI | 1003814005 |
---|---|
Provider Name | Dr. John Warren Lewis JR. |
First Address | Richmond, VA 23227-1149 |
Second Address | Colonial Heights, VA 23834-1765 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/07/2005 |
Last Update Date | 05/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
005645344 | (05) | VA |
H51102 | (02) | VA |