Provider Demographics
NPI:1114507357
Name:LEWIS, DEVON
Entity type:Individual
Prefix:
First Name:DEVON
Middle Name:
Last Name:LEWIS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4601 E FORT LOWELL RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-1183
Mailing Address - Country:US
Mailing Address - Phone:520-396-4413
Mailing Address - Fax:520-396-4764
Practice Address - Street 1:4601 E FORT LOWELL RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1183
Practice Address - Country:US
Practice Address - Phone:520-396-4413
Practice Address - Fax:520-396-4764
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-12
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12151354-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty