MEDICARE: MR. STEVEN RUCKER LEWIS JR. PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1033619275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEVEN RUCKER LEWIS JR. PA-C

Provider Business Mailing Address
First Line	:	12700 PARK CENTRAL DR STE 900
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75251-1542
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	12700 PARK CENTRAL DR STE 900
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75251-1542
Country	:	US
Telephone Number	:	214-860-6051
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/14/2018
Last Update Date	:	02/14/2018

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Directions to “ MR. STEVEN RUCKER LEWIS JR. PA-C” Practice Location

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