Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | MD0000005144 | TN |
NPI | 1033111661 |
---|---|
Provider Name | Myron Lewis |
First Address | Germantown, TN 38138-1727 |
Second Address | Germantown, TN 38138-1727 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2005 |
Last Update Date | 05/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B02223 | (02) | TN |