Basic Information
| Provider Information | |||||||||
| NPI: | 1326319740 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ALAN T. LEWIS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1245 42ND AVE | ||||||||
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| City: | GULFPORT | ||||||||
| State: | MS | ||||||||
| PostalCode: | 395012666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2288648049 | ||||||||
| FaxNumber: | 2288647655 | ||||||||
| Practice Location | |||||||||
| Address1: | 4421 CHASTANT ST | ||||||||
| Address2: | |||||||||
| City: | METAIRIE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 700062053 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2288648049 | ||||||||
| FaxNumber: | 2288647655 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2012 | ||||||||
| LastUpdateDate: | 01/17/2012 | ||||||||
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| AuthorizedOfficialLastName: | LEWIS | ||||||||
| AuthorizedOfficialFirstName: | ALAN | ||||||||
| AuthorizedOfficialMiddleName: | THOMAS | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 2288648049 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | MD14710R | LA | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology | 207ND0101X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology | MOHS-Micrographic Surgery |
No ID Information.