Healthcare Provider Details

I. General information

NPI: 1649590944
Provider Name (Legal Business Name): JAMES JUSTIN LEWIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 N WASHINGTON AVE BAYLOR INSTITUTE FOR REHABILITATION
DALLAS TX
75246-1520
US

IV. Provider business mailing address

909 N WASHINGTON AVE BAYLOR INSTITUTE FOR REHABILITATION
DALLAS TX
75246-1520
US

V. Phone/Fax

Practice location:
  • Phone: 214-820-9300
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberP7417
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: