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Individual
JACK ROY LEWIN
Active
Individual
JACK ROY LEWIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207ZP0101X
Anatomic Pathology Physician
Primary
10322
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00121874
—
MS
05
—
178569
—
AL
01
—
220028560
MEDICARE RR
MS
01
—
4004816
BC OF TN
—
01
—
P00340883
MEDICARE RR
MS
01
—
P00454188
RR MEDICARE
MS
01
—
P01236759
RAILROAD MEDICARE
MS
Enumeration date
07/09/2005
Last updated
11/17/2015
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