Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2081P2900X | Pain Medicine | A83972 | CA |
Y | 2081P2900X | Pain Medicine | MD00048246 | WA |
NPI | 1073724290 |
---|---|
Provider Name | Jamie Lee Lewis |
First Address | Spokane, WA 99210-0112 |
Second Address | Spokane, WA 99223-4942 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2007 |
Last Update Date | 31/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P00420371 | RAILROAD MEDICARE (01) | WA |