Provider Demographics
NPI:1033312426
Name:LEWIS, KEVIN W (DO)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:W
Last Name:LEWIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13830 SAWYER RANCH RD STE 102
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-5514
Mailing Address - Country:US
Mailing Address - Phone:512-301-6400
Mailing Address - Fax:512-301-6401
Practice Address - Street 1:13830 SAWYER RANCH RD
Practice Address - Street 2:SUITE 102
Practice Address - City:DRIPPING SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:78620-5513
Practice Address - Country:US
Practice Address - Phone:512-301-6400
Practice Address - Fax:512-301-6401
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN3143207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX614088Medicare UPIN
TX210403601Medicaid