Provider Demographics
NPI:1093737728
Name:LEWIS, ROBERT S (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
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 1:1100 ANDRE ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:NEW IBERIA
Mailing Address - State:LA
Mailing Address - Zip Code:70563-2159
Mailing Address - Country:US
Mailing Address - Phone:337-364-8890
Mailing Address - Fax:337-364-8552
Practice Address - Street 1:2308 E MAIN ST STE F
Practice Address - Street 2:
Practice Address - City:NEW IBERIA
Practice Address - State:LA
Practice Address - Zip Code:70560-4029
Practice Address - Country:US
Practice Address - Phone:337-364-8890
Practice Address - Fax:337-364-8552
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA08098R207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1394840Medicaid
LA08098ROtherMD
LA5L953Medicare PIN
LA08098ROtherMD