Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | 19949 | OK |
N | 207RP1001X | Pulmonary Disease | 19949 | OK |
Y | 207RS0012X | Sleep Medicine | 19949 | OK |
NPI | 1043222532 |
---|---|
Provider Name | Dr. Kevin Lane Lewis |
First Address | Tulsa, OK 74104-4243 |
Second Address | Tulsa, OK 74104-4243 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2006 |
Last Update Date | 19/05/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G73145 | (02) | OK |