Basic Information
| Provider Information | |||||||||
| NPI: | 1649509506 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | WINSLOW | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 323 W ALDER ST | ||||||||
| Address2: | |||||||||
| City: | MISSOULA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598024123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062584195 | ||||||||
| FaxNumber: | 4062584180 | ||||||||
| Practice Location | |||||||||
| Address1: | 323 W ALDER ST | ||||||||
| Address2: | |||||||||
| City: | MISSOULA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598024123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062584195 | ||||||||
| FaxNumber: | 4062584180 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/23/2009 | ||||||||
| LastUpdateDate: | 11/10/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 592 | MT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.