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NPI Code Detail

MEDICARE: DR. ADOLPHUS RAY LEWIS DO

MEDICARE:  DR. ADOLPHUS RAY LEWIS  DO
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
1207Q00000XFamily Medicine PhysicianH2532TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2P00864759OTHERTXPALMETTO GBA RAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18CG231OTHERTXBLUE CROSS BLUE SHIELD
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265403497
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ADOLPHUS RAY LEWIS DO
Provider Business Mailing Address
First Line : 4732 E LANCASTER AVE STE A
Second Line :
City : FORT WORTH
State : TX
Zip : 76103-3836
Country : US
Telephone Number : 817-534-1010
Fax Number : 817-413-0300
Provider Business Practice Location Address
First Line : 4732 E LANCASTER AVE STE A
Second Line :
City : FORT WORTH
State : TX
Zip : 76103-3836
Country : US
Telephone Number : 817-534-1010
Fax Number : 817-413-0300
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2006
Last Update Date : 09/23/2016

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Directions to “ DR. ADOLPHUS RAY LEWIS DO” Practice Location

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