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General NPI Number Information
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NPI Number | 1558397612
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Entity Type | Individual
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Provider Name | WAYMON EDWARD LEWIS JR. DPM
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Gender | Male
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 07/17/2013
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Provider Practice Location Address
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Address Line | 224 SANTA FE DR SUITE 300
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City | WEATHERFORD
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State | TX
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Zip | 76086-6574
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Country | US
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Telephone | 817-341-3901
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Fax | 817-599-7018
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Provider Business Mailing Address
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Address Line | PO BOX 1926
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City | WEATHERFORD
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State | TX
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Zip | 76086-7926
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Country | US
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Telephone | 817-341-3901
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Fax | 817-599-7018
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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 | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 1477
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License Number State | TX
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