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NPI Code Detail

MEDICARE: A RAY LEWIS DO PA

MEDICARE: A RAY LEWIS DO PA
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
1207QG0300XGeriatric Medicine (Family Medicine) Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1080012814OTHERTXPALMETTO GBA
20064QFOTHERTXBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1578534541
Entity Type Code : Organization
Provider Name (Legal Business Name) : A RAY LEWIS DO PA
Provider Business Mailing Address
First Line : 4732 E LANCASTER ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76103-3836
Country : US
Telephone Number : 817-534-1010
Fax Number : 817-413-0300
Provider Business Practice Location Address
First Line : 4732 E. LANCASTER ST
Second Line :
City : FORT WORTH
State : TX
Zip : 76103-3836
Country : US
Telephone Number : 817-534-1010
Fax Number : 817-413-0300
Authorized Official
Title or Position : OWNER/PHYSICIAN
Name : DR. ADOLPHUS RAY LEWIS
Credential : DO
Telephone Number : 817-534-1010
Provider Enumeration Date : 01/30/2006
Last Update Date : 01/31/2008

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Directions to “A RAY LEWIS DO PA ” Practice Location

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