Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | MD42737 | WA |
NPI | 1275603037 |
---|---|
Provider Name | Dr. Loren Lew Lewis |
First Address | Spokane, WA 99205-6185 |
Second Address | Spokane, WA 99205-6185 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/11/2006 |
Last Update Date | 02/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G8907637 | (02) | WA |