Basic Information
| Provider Information | |||||||||
| NPI: | 1366442329 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | ALAN | ||||||||
| MiddleName: | G | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6475 S YALE AVE | ||||||||
| Address2: | STE. 301 | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741367816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184949300 | ||||||||
| FaxNumber: | 9184949324 | ||||||||
| Practice Location | |||||||||
| Address1: | 6475 S YALE AVE | ||||||||
| Address2: | STE. 301 | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741367816 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184949300 | ||||||||
| FaxNumber: | 9184949324 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/29/2005 | ||||||||
| LastUpdateDate: | 05/17/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XX0004X | 14551 | OK | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery | 207X00000X | 14551 | OK | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.