Provider Demographics
NPI:1033268578
Name:LEWIS, SAMUEL (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3245 W MAIN ST
Mailing Address - Street 2:SUITE 235-376
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4411
Mailing Address - Country:US
Mailing Address - Phone:214-729-1650
Mailing Address - Fax:214-722-1790
Practice Address - Street 1:11335 ALTAMONT DR
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-1182
Practice Address - Country:US
Practice Address - Phone:214-729-1650
Practice Address - Fax:214-722-1790
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2011-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE76522085N0904X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear CardiologyGroup - Single Specialty
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8C8371Medicare ID - Type UnspecifiedINDIVIDUAL
TXE48694Medicare UPIN