Provider Demographics
NPI:1073724290
Name:LEWIS, JAMIE LEE (MD)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LEE
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 112
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99210-0112
Mailing Address - Country:US
Mailing Address - Phone:509-464-6208
Mailing Address - Fax:888-316-1928
Practice Address - Street 1:3124 S REGAL ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99223-4704
Practice Address - Country:US
Practice Address - Phone:509-464-6208
Practice Address - Fax:888-316-1928
Is Sole Proprietor?:No
Enumeration Date:2007-05-28
Last Update Date:2024-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA839722081P2900X
WAMD000482462081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00420371OtherRAILROAD MEDICARE
WA8866713OtherNORIDIAN MEDICARE
ID1135604OtherCIGNA MEDICARE
WAP00420371OtherRAILROAD MEDICARE