Provider Demographics
NPI:1659080034
Name:LEWIS, STACY
Entity Type:Individual
Prefix:MR
First Name:STACY
Middle Name:
Last Name:LEWIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 W WHEATLAND RD # 444
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-4520
Mailing Address - Country:US
Mailing Address - Phone:972-266-3447
Mailing Address - Fax:
Practice Address - Street 1:3063 GRAYSON DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75224-3307
Practice Address - Country:US
Practice Address - Phone:214-597-6176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-15
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver