MEDICARE: DAVID RAY LEWIS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	66139	AZ
2	390200000X	Student in an Organized Health Care Education/Training Program
3	2084P0800X	Psychiatry Physician	32260	WV

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154828663
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID RAY LEWIS MD

Provider Business Mailing Address
First Line	:	4531 N 16TH ST STE 114
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85016-5344
Country	:	US
Telephone Number	:	602-266-8700
Fax Number	:	602-296-0404

Provider Business Practice Location Address
First Line	:	36457 N GANTZEL RD STE 102
Second Line	:
City	:	SAN TAN VALLEY
State	:	AZ
Zip	:	85140-7343
Country	:	US
Telephone Number	:	480-764-1900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/11/2018
Last Update Date	:	05/28/2026

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Directions to “ DAVID RAY LEWIS MD” Practice Location

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