1376006965 NPI number — DR. JADE JONEE LEWIS MD

Table of content: DR. JADE JONEE LEWIS MD (NPI 1376006965)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376006965 NPI number — DR. JADE JONEE LEWIS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEWIS
Provider First Name:
JADE
Provider Middle Name:
JONEE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376006965
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/04/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PSC 557 BOX 415
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FPO
Provider Business Mailing Address State Name:
AP
Provider Business Mailing Address Postal Code:
96379-0005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-622-9953
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
U.S. NAVAL HOSPITAL OKINAWA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHATAN
Provider Business Practice Location Address State Name:
OKINAWA PREFECTURE
Provider Business Practice Location Address Postal Code:
9040103
Provider Business Practice Location Address Country Code:
JP
Provider Business Practice Location Address Telephone Number:
315-622-7632
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/10/2019

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: ME146984 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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