Provider Demographics
NPI:1962628339
Name:LEWIS & WAKEFIELD, PLLC
Entity type:Organization
Organization Name:LEWIS & WAKEFIELD, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:H
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:918-299-8080
Mailing Address - Street 1:615 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:JENKS
Mailing Address - State:OK
Mailing Address - Zip Code:74037-4138
Mailing Address - Country:US
Mailing Address - Phone:918-299-8080
Mailing Address - Fax:918-298-2838
Practice Address - Street 1:615 E MAIN ST
Practice Address - Street 2:
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-4138
Practice Address - Country:US
Practice Address - Phone:918-299-8080
Practice Address - Fax:918-298-2838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200058160BMedicaid
OK200058160COtherO-EPIC
OK=========001OtherBLUE CROSS BLUE SHIELD GR
OK200058160COtherO-EPIC
OK=========001OtherBLUE CROSS BLUE SHIELD GR