Individual
MR. SAMUEL GRADY LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RTR,RPA,RA,CBRPA
Contact information
Practice address
308 FAIRVIEW AVE, PONCA CITY, OK 74601-2001
(580) 765-9588
(580) 762-1367
Mailing address
308 FAIRVIEW AVE, PONCA CITY, OK 74601-2001
(580) 765-9588
(580) 762-1367
Taxonomy
Speciality
Code
Description
License number
State
2471C3402X
Radiography Radiologic Technologist
Primary
—
—
Other
Enumeration date
08/13/2007
Last updated
08/13/2007
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