Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0117X | Orthopaedic Spine Surgeon | MD13887 | OR |
NPI | 1295779734 |
---|---|
Provider Name | Dr. Todd Jay Lewis |
First Address | Corvallis, OR 97330-3887 |
Second Address | Corvallis, OR 97330-3887 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 06/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C93149 | (02) | OR |