Individual
JEROMY R LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
559 S GOODYEAR ST, OREGON, OH 43616-2955
(419) 696-0176
Mailing address
559 S GOODYEAR ST, OREGON, OH 43616-2955
(419) 696-0176
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
35-088996
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000568391
ANTHEM
OH
05
—
2780825
—
OH
01
—
35-088996
STATE MEDICAL LICENSE
OH
Enumeration date
04/12/2007
Last updated
11/07/2008
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