Provider Demographics
NPI:1992786768
Name:LEWIS, JAMES ANDREW
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:ANDREW
Last Name:LEWIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:HASTING INDIAN MEDICAL CENTER
Mailing Address - Street 2:100 S. BLISS
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464
Mailing Address - Country:US
Mailing Address - Phone:918-458-3120
Mailing Address - Fax:918-458-3279
Practice Address - Street 1:HASTING INDIAN MEDICAL CENTER
Practice Address - Street 2:100 S. BLISS
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464
Practice Address - Country:US
Practice Address - Phone:918-458-3120
Practice Address - Fax:918-458-3279
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10026208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK10038540AMedicaid
AR150304001Medicaid
OK10038540AMedicaid
AR150304001Medicaid