MEDICARE: LEWIS MILTON DEVORE P.A.

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	PA00675	TX

General Provider Information

NPI Number	:	1316018385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEWIS MILTON DEVORE P.A.

Provider Business Mailing Address
First Line	:	218 WESTRIDGE DR.
Second Line	:
City	:	HUNTSVILLE
State	:	TX
Zip	:	77340
Country	:	US
Telephone Number	:	936-295-7151
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 ALPINE ST
Second Line	:
City	:	COLDSPRING
State	:	TX
Zip	:	77331-8058
Country	:	US
Telephone Number	:	936-653-5861
Fax Number	:

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

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	07/08/2007

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Directions to “ LEWIS MILTON DEVORE P.A.” Practice Location

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