Provider Demographics
NPI:1225144884
Name:LEWIS K. CLARKE, M.D., P.A.
Entity Type:Organization
Organization Name:LEWIS K. CLARKE, M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:K
Authorized Official - Last Name:CLARKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-332-1755
Mailing Address - Street 1:PO BOX 57995
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-7995
Mailing Address - Country:US
Mailing Address - Phone:281-332-1755
Mailing Address - Fax:281-332-2737
Practice Address - Street 1:17448 HIGHWAY 3
Practice Address - Street 2:SUITE 130
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4197
Practice Address - Country:US
Practice Address - Phone:281-332-1755
Practice Address - Fax:281-332-2737
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080029401Medicaid
TX080029401Medicaid