Individual
GORDON BRAXTON LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
504 CHERRY ST, MIDDLEBOURNE, WV 26149-9618
(304) 758-4919
(304) 758-4680
Mailing address
PO BOX 68, MIDDLEBOURNE, WV 26149-0068
(304) 758-4919
(304) 758-4680
Taxonomy
Speciality
Code
Description
License number
State
376J00000X
Homemaker
Primary
—
—
Other
Enumeration date
09/28/2021
Last updated
09/28/2021
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