Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 7793 | TN |
NPI | 1174530729 |
---|---|
Provider Name | Dr. John West Lewis III |
First Address | Memphis, TN 38104 |
Second Address | Memphis, TN 38104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2006 |
Last Update Date | 08/07/2007 |