Healthcare Provider Details

I. General information

NPI: 1598726408
Provider Name (Legal Business Name): RICHARD M. LEWIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12221 MOPAC EXPRESSWAY NORTH
AUSTIN TX
78758-2483
US

IV. Provider business mailing address

12221 MOPAC EXPRESSWAY NORTH
AUSTIN TX
78758-2483
US

V. Phone/Fax

Practice location:
  • Phone: 512-901-4019
  • Fax: 512-901-3919
Mailing address:
  • Phone: 512-901-4019
  • Fax: 512-901-3919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberH1615
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: