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Individual

CHAD ALLAN LEWIS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA

Contact information

Practice address
4543 E PEARSON MEADOW DR, SPRINGFIELD, MO 65802-6242
(417) 350-3050
Mailing address
4543 E PEARSON MEADOW DR, SPRINGFIELD, MO 65802-6242
(417) 350-3050

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2012007269
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
220024475
MO
01
431767432
TRICARE
MO
Enumeration date
03/13/2012
Last updated
01/17/2020
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