Individual
MR. PETER WALLACE LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
6294 STATE HIGHWAY 154, SESSER, IL 62884-2163
(618) 625-6979
Mailing address
PO BOX 155, CHRISTOPHER, IL 62822-0155
(618) 724-2401
(618) 724-4628
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA01533
TX
Other
Enumeration date
09/16/2006
Last updated
01/18/2012
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