Individual
DR. MARJORIE A. LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
807 CHILDRENS WAY, JACKSONVILLE, FL 32207-8426
(904) 697-3694
(302) 651-4945
Mailing address
PO BOX 191, PROVIDER ENROLLMENT DEPT, ROCKLAND, DE 19732-0191
(302) 651-6212
(302) 651-4945
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
ME80214
FL
207LP3000X
Pediatric Anesthesiology Physician
Primary
ME80214
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000862188A
—
GA
05
—
258591000
—
FL
05
—
4047440
—
TN
Enumeration date
08/10/2006
Last updated
04/11/2016
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