Provider Demographics
NPI:1609853928
Name:LEWIS, RONALD MOORE (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:MOORE
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:4150 NELSON RD.
Mailing Address - Street 2:BUILDING A-SUITE 4 ANESTHESIA ASSOCIATES
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605
Mailing Address - Country:US
Mailing Address - Phone:337-474-6353
Mailing Address - Fax:337-477-7616
Practice Address - Street 1:4150 NELSON RD.
Practice Address - Street 2:BUILDING A-SUITE 4 ANESTHESIA ASSOCIATES
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605
Practice Address - Country:US
Practice Address - Phone:337-474-6353
Practice Address - Fax:337-477-7616
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA3141R207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1118435Medicaid
LA050015513OtherRAILROAD MEDICARE PIN
LA53578Medicare PIN
LAB64713Medicare UPIN