Individual
DR. GIDEON GRIFFETH LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
650 N WYMORE RD, SUITE 202, WINTER PARK, FL 32789-2859
(407) 647-0199
(407) 647-0213
Mailing address
650 N WYMORE RD, SUITE 202, WINTER PARK, FL 32789-2859
(407) 647-0199
(407) 647-0213
Taxonomy
Speciality
Code
Description
License number
State
207QA0000X
Adolescent Medicine (Family Medicine) Physician
ME 29256
FL
207QA0505X
Adult Medicine Physician
Primary
ME 29256
FL
207QG0300X
Geriatric Medicine (Family Medicine) Physician
ME 29256
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
064809400
—
FL
01
—
080137252
RAILROAD MEDICARE ID
FL
01
—
2134653
AETNA HMO ID
FL
01
—
2403499008
CIGNA HEALTHCARE ID
FL
01
—
4311031
AETNA PPO/POS ID
FL
01
—
59249
BCBS ID
FL
01
—
ME 29256
STATE LICENSE
FL
Enumeration date
01/12/2006
Last updated
04/28/2008
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