1184738320 NPI number — FREDERICK W LEWIS M.D.

Table of content: FREDERICK W LEWIS M.D. (NPI 1184738320)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184738320 NPI number — FREDERICK W LEWIS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEWIS
Provider First Name:
FREDERICK
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEWIS
Provider Other First Name:
FRED
Provider Other Middle Name:
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1184738320
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10103 RIDGEGATE PKWY
Provider Second Line Business Mailing Address:
STE 312
Provider Business Mailing Address City Name:
LONE TREE
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80124-5520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-788-8888
Provider Business Mailing Address Fax Number:
303-790-2567

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
499 E HAMPDEN AVE
Provider Second Line Business Practice Location Address:
STE 420
Provider Business Practice Location Address City Name:
ENGLEWOOD
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80113-2780
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-788-8888
Provider Business Practice Location Address Fax Number:
303-790-2567
Provider Enumeration Date:
08/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  28833 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1184738320 . This is a "NPPES NPI" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: 01288331 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".