Healthcare Provider Details

I. General information

NPI: 1750553491
Provider Name (Legal Business Name): ANNE MEREDITH LEWIS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2008
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 STONECIPHER BLVD
ADA OK
74820-3439
US

IV. Provider business mailing address

1921 STONECIPHER BLVD
ADA OK
74820-3439
US

V. Phone/Fax

Practice location:
  • Phone: 580-436-3980
  • Fax:
Mailing address:
  • Phone: 580-436-3980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number37560
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4083
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier334709801
Identifier TypeMEDICAID
Identifier StateTX
Identifier Issuer
# 2
Identifier334709802
Identifier TypeMEDICAID
Identifier StateTX
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: