Basic Information
| Provider Information | |||||||||
| NPI: | 1811903255 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | FLORENCE | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6600 S YALE AVE | ||||||||
| Address2: | STE 1200 | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741363361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184886687 | ||||||||
| FaxNumber: | 9184886098 | ||||||||
| Practice Location | |||||||||
| Address1: | 6151 S YALE AVE STE 1305 | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741361907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184949450 | ||||||||
| FaxNumber: | 9184949437 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 06/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0120X | J5604 | TX | N | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery | 2086S0120X | 8950 | SD | N | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery | 2086S0120X | 41103 | IA | N | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery | 2086S0120X | ME89224 | FL | N | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery | 2086S0120X | 29923 | OK | Y | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery |
ID Information
| ID | Type | State | Issuer | Description | 05435273 | 05 | MS | MEDICAID | Q009186 | 05 | TN | MEDICAID | 009951795 | 05 | AL | MEDICAID | 214450001 | 05 | AR | MEDICAID | 270271100 | 05 | FL | MEDICAID |