Provider Demographics
NPI:1144436510
Name:LEWIS, JEFFREY W (MD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:W
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:16400 HEALTHPARK COMMONS DR
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-9621
Practice Address - Country:US
Practice Address - Phone:239-278-5200
Practice Address - Fax:239-278-4243
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53401174400000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL07160OtherBLUE CROSS & BLUE SHIELD
FL3178924OtherCIGNA
FLA003OtherTRICARE
P108801OtherFREEDOM HEALTH
FL235567OtherAVMED
FL4091413OtherAETNA
FLP944515OtherOPTIMUM
FL616993502OtherDEPARTMENT OF ENERGY
FL020011787OtherRAILROAD MEDICARE
FL049245100Medicaid
FL15914OtherWELLCARE
FLP01123877OtherRAILROAD MCR
FL07160YMedicare PIN
FL07160XMedicare PIN
FL15914OtherWELLCARE
FL3178924OtherCIGNA