Individual
MR. CODY W LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2300 E 30TH ST BLDG D STE 101, FARMINGTON, NM 87401
(505) 327-1400
(505) 564-3202
Mailing address
2300 E 30TH ST BLDG D STE 101, FARMINGTON, NM 87401
(505) 327-1400
(505) 564-3202
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA2012-0021
NM
363AM0700X
Medical Physician Assistant
PA60796883
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
58372539
—
NM
Enumeration date
08/02/2012
Last updated
01/18/2021
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