Provider Demographics
NPI:1558689182
Name:LEWIS, JUSTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:
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 1:3070 COLLEGE ST
Mailing Address - Street 2:STE 401
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4691
Mailing Address - Country:US
Mailing Address - Phone:409-839-0088
Mailing Address - Fax:318-300-4728
Practice Address - Street 1:3070 COLLEGE ST
Practice Address - Street 2:STE 401
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4691
Practice Address - Country:US
Practice Address - Phone:409-839-0088
Practice Address - Fax:318-300-4728
Is Sole Proprietor?:No
Enumeration Date:2010-05-06
Last Update Date:2015-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXP6016207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3344285Medicaid
TX323518YV3KMedicare PIN