Provider Demographics
NPI:1548213267
Name:LEWIS, RORY HOWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:RORY
Middle Name:HOWARD
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:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TN
Mailing Address - Zip Code:38570
Mailing Address - Country:US
Mailing Address - Phone:931-403-2663
Mailing Address - Fax:931-403-6094
Practice Address - Street 1:506 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TN
Practice Address - Zip Code:38570-1718
Practice Address - Country:US
Practice Address - Phone:931-823-2663
Practice Address - Fax:931-403-6094
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2017-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK6097207X00000X
TN56282207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX031079902Medicaid
TX113762050OtherTRICARE
TX117797102OtherFIRST CARE
TX848010OtherBLUE CROSS BLUE SHIELD
TX113762050OtherTRICARE
TXH04549Medicare UPIN