Provider Demographics
NPI:1124005152
Name:LEWIS, JERRY WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:JERRY
Middle Name:WAYNE
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 1:5757 WARREN PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-4273
Mailing Address - Country:US
Mailing Address - Phone:214-618-9600
Mailing Address - Fax:214-618-7997
Practice Address - Street 1:11500 STATE HIGHWAY 121 STE 810
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75035-9347
Practice Address - Country:US
Practice Address - Phone:214-618-9622
Practice Address - Fax:833-753-1061
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8208207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX137545313Medicaid
TX137545314Medicaid
TX137545316Medicaid
TX137545311Medicaid
TX8A4769OtherBCBS
TX137545315Medicaid
TX8A4771Medicare PIN
TX8A4770Medicare PIN
E78712Medicare UPIN
TX137545315Medicaid
TX137545311Medicaid