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General NPI Number Information
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NPI Number | 1093935801
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Entity Type | Organization
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Legal Business Name | LEWIS PODIATRY GROUP PA
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Dates
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Enumeration Date | 04/26/2007
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Last Update Date | 05/06/2008
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Provider Practice Location Address
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Address Line | 504 N CARRIER PKWY
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City | GRAND PRAIRIE
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State | TX
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Zip | 75050-5428
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Country | US
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Telephone | 973-263-7042
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Fax | 972-263-7046
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Provider Business Mailing Address
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Address Line | 504 N CARRIER PKWY
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City | GRAND PRAIRIE
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State | TX
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Zip | 75050-5428
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Country | US
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Telephone | 973-263-7042
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Fax | 972-263-7046
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRANDON J LEWIS
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Credential | DPM
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Telephone | 972-263-7042
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 1574
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License Number State | TX
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