Healthcare Provider Details

I. General information

NPI: 1477016418
Provider Name (Legal Business Name): RAFAEL LEMUS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2019
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 FOREST LN
DALLAS TX
75230-2571
US

IV. Provider business mailing address

1121 E SPRING CREEK PKWY. STE. 110, #319
PLANO TX
75074
US

V. Phone/Fax

Practice location:
  • Phone: 214-343-6663
  • Fax:
Mailing address:
  • Phone: 214-343-6663
  • Fax: 214-343-2814

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberT9166
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberT9166
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: