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Individual

KYLE LEWIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
11216 SUNRISE BLVD E, STE 3-207, PUYALLUP, WA 98374-8848
(253) 770-3700
(253) 435-7019
Mailing address
3209 S 23RD ST, STE 340, TACOMA, WA 98405-1602
(253) 503-2598
(253) 404-0506

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA60520595
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2042164
WA
Enumeration date
01/26/2015
Last updated
09/29/2015
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