MEDICARE: DR. CHARLES TURNER LEWIS III M.D.

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	208000000X	Pediatrics Physician	J0770	TX

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	752551507	OTHER	TX	TAX ID
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962406744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHARLES TURNER LEWIS III M.D.

Provider Business Mailing Address
First Line	:	1011 W GROVE ST
Second Line	:	STE 100
City	:	KAUFMAN
State	:	TX
Zip	:	75142-1827
Country	:	US
Telephone Number	:	972-932-1319
Fax Number	:	972-932-1388

Provider Business Practice Location Address
First Line	:	1011 W GROVE ST
Second Line	:	STE 100
City	:	KAUFMAN
State	:	TX
Zip	:	75142-1827
Country	:	US
Telephone Number	:	972-932-1319
Fax Number	:	972-932-1388

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	05/30/2013

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