Provider Demographics
NPI:1689773459
Name:LEWIS, HAROLD D (DO)
Entity Type:Individual
Prefix:DR
First Name:HAROLD
Middle Name:D
Last Name:LEWIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1901 W WILLIAM CANNON DR
Mailing Address - Street 2:SUITE 123
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-5371
Mailing Address - Country:US
Mailing Address - Phone:512-444-2661
Mailing Address - Fax:512-444-2720
Practice Address - Street 1:1901 W WILLIAM CANNON DR
Practice Address - Street 2:SUITE 123
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-5371
Practice Address - Country:US
Practice Address - Phone:512-444-2661
Practice Address - Fax:512-444-2720
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-21
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE6126207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00BL17OtherBCBS PIN
TX032268701Medicaid
TX10016231OtherAMERIGROUP NUMBER
TX00BL17OtherBCBS PIN
TX032268701Medicaid