Provider Demographics
NPI:1275723249
Name:BEVERLY GUILLORY LEWIS MD, PA
Entity Type:Organization
Organization Name:BEVERLY GUILLORY LEWIS MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENNICE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-945-0810
Mailing Address - Street 1:1228 N LOGAN ST
Mailing Address - Street 2:STE 200
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77590-5171
Mailing Address - Country:US
Mailing Address - Phone:409-945-0810
Mailing Address - Fax:409-945-6678
Practice Address - Street 1:1021 61ST ST
Practice Address - Street 2:#210
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77550-0000
Practice Address - Country:US
Practice Address - Phone:409-740-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF4211208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00U98ZMedicare PIN