Provider Demographics
NPI:1285688093
Name:LEWIS-TRAYLOR, ANGELA MICHELLE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:MICHELLE
Last Name:LEWIS-TRAYLOR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:MICHELLE
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1207 N HOUSTON AVE
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77338-2591
Mailing Address - Country:US
Mailing Address - Phone:832-916-2422
Mailing Address - Fax:832-916-2522
Practice Address - Street 1:1207 N HOUSTON AVE
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77338-2591
Practice Address - Country:US
Practice Address - Phone:832-916-2422
Practice Address - Fax:832-916-2522
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-19
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXQ32262086X0206X, 208600000X
ORMD 277692086X0206X
KY398362086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX370843001Medicaid