Provider Demographics
NPI:1073519088
Name:LEWIS, RODNEY DUANE (MD)
Entity Type:Individual
Prefix:
First Name:RODNEY
Middle Name:DUANE
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7200 WYOMING SPGS
Mailing Address - Street 2:STE 500
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4307
Mailing Address - Country:US
Mailing Address - Phone:512-244-0111
Mailing Address - Fax:512-244-2479
Practice Address - Street 1:7200 WYOMING SPGS
Practice Address - Street 2:STE 500
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4307
Practice Address - Country:US
Practice Address - Phone:512-244-0111
Practice Address - Fax:512-244-2479
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG8901208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4210671OtherAETNA
TX110505801Medicaid
TX4210671OtherAETNA
TX020047449Medicare PIN
E19454Medicare UPIN