Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 20824 | MS |
N | 207XS0106X | Orthopaedic Hand Surgeon | 20824 | MS |
NPI | 1043229990 |
---|---|
Provider Name | Eric Van Lewis |
First Address | Tupelo, MS 38801-6583 |
Second Address | Tupelo, MS 38801-4751 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/08/2006 |
Last Update Date | 07/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
07451813 | (05) | MS |