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General NPI Number Information
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NPI Number | 1215920640
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Entity Type | Individual
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Provider Name | KATHRYN MARIE LEWIS M.D.
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Gender | Female
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Dates
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Enumeration Date | 08/31/2005
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Last Update Date | 11/16/2007
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Provider Practice Location Address
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Address Line | 4920 N.E. STALLILNGS DRIVE
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City | NACOGDOCHES
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State | TX
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Zip | 75961
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Country | US
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Telephone | 936-568-3493
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Fax | 281-548-3513
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Provider Business Mailing Address
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Address Line | PO BOX 6325
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City | HUMBLE
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State | TX
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Zip | 77325-6325
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Country | US
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Telephone | 281-360-5400
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Fax | 281-548-3513
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | H0564
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License Number State | TX
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