Provider Demographics
NPI:1558397612
Name:LEWIS, WAYMON EDWARD JR (DPM)
Entity Type:Individual
Prefix:DR
First Name:WAYMON
Middle Name:EDWARD
Last Name:LEWIS
Suffix:JR
Gender:M
Credentials:DPM
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 1926
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-7926
Mailing Address - Country:US
Mailing Address - Phone:817-341-3901
Mailing Address - Fax:817-599-7018
Practice Address - Street 1:224 SANTA FE DR
Practice Address - Street 2:SUITE 300
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086-6574
Practice Address - Country:US
Practice Address - Phone:817-341-3901
Practice Address - Fax:817-599-7018
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-23
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1477213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018603301Medicaid
TX10032164OtherAMERIGROUP PROVIDER NUMBE
TX8A3610OtherBCBS PROVIDER NUMBER
TX2374431OtherAETNA HMO PROVIDER NUMBER
TX10032164OtherAMERIGROUP PROVIDER NUMBE
U78002Medicare UPIN