Healthcare Provider Details

I. General information

NPI: 1124005152
Provider Name (Legal Business Name): JERRY WAYNE LEWIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2005
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11500 STATE HIGHWAY 121 STE 810
FRISCO TX
75035-9347
US

IV. Provider business mailing address

11500 STATE HIGHWAY 121 STE 810
FRISCO TX
75035-9347
US

V. Phone/Fax

Practice location:
  • Phone: 214-618-9622
  • Fax: 833-753-1061
Mailing address:
  • Phone: 214-618-9600
  • Fax: 214-618-7997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberH8208
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: