Basic Information
| Provider Information | |||||||||
| NPI: | 1245326917 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | TERRY | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18512 S KANAGA LOOP | ||||||||
| Address2: | |||||||||
| City: | EAGLE RIVER | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995778675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9078309557 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3300 PROVIDENCE DR | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | ANCHORAGE | ||||||||
| State: | AK | ||||||||
| PostalCode: | 995084616 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9075610005 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 4750 | AK | Y | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.