Provider Demographics
NPI:1871572206
Name:LEWIS, GIDEON JAWAHARLAL (DPM)
Entity type:Individual
Prefix:DR
First Name:GIDEON
Middle Name:JAWAHARLAL
Last Name:LEWIS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 N WYMORE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2859
Mailing Address - Country:US
Mailing Address - Phone:407-647-0199
Mailing Address - Fax:407-647-0213
Practice Address - Street 1:650 N WYMORE RD
Practice Address - Street 2:SUITE 202
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2859
Practice Address - Country:US
Practice Address - Phone:407-647-0199
Practice Address - Fax:407-647-0213
Is Sole Proprietor?:No
Enumeration Date:2006-01-13
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO3239213E00000X, 213EP1101X, 213ER0200X, 213ES0000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ER0200XPodiatric Medicine & Surgery Service ProvidersPodiatristRadiology
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7530981OtherCIGNA
FL7581866OtherAETNA
FLPO3239OtherLICENSE
FLP00423470OtherRAILROAD MEDICARE
FLU7776ZMedicare PIN
FLV10063Medicare UPIN