Provider Demographics
NPI:1578534541
Name:A RAY LEWIS DO PA
Entity Type:Organization
Organization Name:A RAY LEWIS DO PA
Other - Org Name:EAST FORT WORTH MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ADOLPHUS
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-534-1010
Mailing Address - Street 1:4732 E LANCASTER ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76103-3836
Mailing Address - Country:US
Mailing Address - Phone:817-534-1010
Mailing Address - Fax:817-413-0300
Practice Address - Street 1:4732 E. LANCASTER ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76103-3836
Practice Address - Country:US
Practice Address - Phone:817-534-1010
Practice Address - Fax:817-413-0300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-30
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080012814OtherPALMETTO GBA
TX0064QFOtherBLUE CROSS BLUE SHIELD