Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 23036 | MS |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 23036 | MS |
NPI | 1003043506 |
---|---|
Provider Name | Matthew Wesley Lewis |
First Address | Vancleave, MS 39565-6770 |
Second Address | Vancleave, MS 39565-6770 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2009 |
Last Update Date | 22/03/2017 |