Provider Demographics
NPI:1669458568
Name:LEWIS, ROBERT B JR (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:B
Last Name:LEWIS
Suffix:JR
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:PO BOX 840853
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-0865
Mailing Address - Country:US
Mailing Address - Phone:972-715-5000
Mailing Address - Fax:
Practice Address - Street 1:6606 LBJ FWY STE 200
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6524
Practice Address - Country:US
Practice Address - Phone:972-715-5000
Practice Address - Fax:972-715-9976
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH0565207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX050065899OtherRAIL ROAD
TX127814502Medicaid
TX127814509Medicaid
TX8EH536OtherBCBS TX
TX127814507OtherMEDICAID CSHCN
TX127814508OtherMEDICAID CSHCN
TX137545314Medicaid
TX127814506Medicaid
TX83759KOtherBCBS
TX050065899OtherRAIL ROAD
TX88981KMedicare PIN
TX127814507OtherMEDICAID CSHCN
E02217Medicare UPIN
TX137545314Medicaid
TX83759KMedicare PIN
TX361977YK6UMedicare PIN