MEDICARE: A RAY LEWIS, DO, PLLC

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	207Q00000X	Family Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	DQ6866	OTHER	TX	PALMETTO GBA RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	0068TD	OTHER	TX	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1053643130
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A RAY LEWIS, DO, PLLC

Provider Business Mailing Address
First Line	:	4732 E LANCASTER AVE STE A
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76103-3836
Country	:	US
Telephone Number	:	817-413-0943
Fax Number	:	817-413-0300

Provider Business Practice Location Address
First Line	:	4732 E LANCASTER AVE STE A
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76103-3836
Country	:	US
Telephone Number	:	817-413-0943
Fax Number	:	817-413-0300

Authorized Official
Title or Position	:	OWNER/PHYSICIAN
Name	:	DR. ADOLPHUS RAY LEWIS
Credential	:	DO
Telephone Number	:	817-413-0943

Provider Enumeration Date	:	02/01/2010
Last Update Date	:	05/26/2015

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Directions to “A RAY LEWIS, DO, PLLC ” Practice Location

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