=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639115215
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GARY LEW D.O.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/21/2006
-----------------------------------------------------
Last Update Date | 07/09/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1111 HIGHWAY 6 SUITE 225
-----------------------------------------------------
City | SUGAR LAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77478-4914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-277-4600
-----------------------------------------------------
Fax | 281-277-5834
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1111 HIGHWAY 6 SUITE 225
-----------------------------------------------------
City | SUGAR LAND
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77478-4914
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-277-4600
-----------------------------------------------------
Fax | 281-277-5834
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | JO574
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------