Individual
JACK ROY LEWIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-1530
(601) 984-1531
Mailing address
2500 N STATE ST, JACKSON, MS 39216-4500
(601) 984-1530
(601) 984-1531
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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