Provider Demographics
NPI:1326014523
Name:LEWIS, RONALD MOORE JR (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:MOORE
Last Name:LEWIS
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 122205
Mailing Address - Street 2:DEPT 2205
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75312-2205
Mailing Address - Country:US
Mailing Address - Phone:337-494-6897
Mailing Address - Fax:337-494-2928
Practice Address - Street 1:2770 3RD AVE STE 350
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-0404
Practice Address - Country:US
Practice Address - Phone:337-494-6800
Practice Address - Fax:337-494-6811
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2022-02-24
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Provider Licenses
StateLicense IDTaxonomies
LA12248207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1695742Medicaid
LAMD.12248ROtherSTATE MEDICAL LICENSE
5Y423Medicare PIN