Individual
JIMMY LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
399 TILLERY LN, WATTS, OK 74964-5072
(918) 422-0028
(918) 422-0027
Mailing address
PO BOX 241, SILOAM SPRINGS, AR 72761-0241
(918) 422-0028
(918) 422-0027
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
02/26/2020
Last updated
02/26/2020
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