Provider Demographics
NPI:1548451404
Name:UNDERWOOD, LEWIS DONALD (NMD)
Entity type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:DONALD
Last Name:UNDERWOOD
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:DR
Other - First Name:DON
Other - Middle Name:
Other - Last Name:UNDERWOOD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NMD
Mailing Address - Street 1:42323 N VISION WAY
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-1490
Mailing Address - Country:US
Mailing Address - Phone:623-551-0027
Mailing Address - Fax:623-551-1768
Practice Address - Street 1:42323 N VISION WAY
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-1490
Practice Address - Country:US
Practice Address - Phone:623-551-0027
Practice Address - Fax:623-551-1768
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0471171100000X
AZ06-929175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist