Provider Demographics
NPI:1821025305
Name:LEWIS, DOUGLAS T (MD)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:T
Last Name:LEWIS
Suffix:
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 1:9088 LOVING BR
Mailing Address - Street 2:
Mailing Address - City:LANTANA
Mailing Address - State:TX
Mailing Address - Zip Code:76226-7302
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:NORTH TEXAS MEDICAL CENTER
Practice Address - Street 2:1900 HOSPITAL BLVD
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:96240
Practice Address - Country:US
Practice Address - Phone:940-665-1751
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9536207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXA002Medicaid
TXE92357Medicare UPIN
TX137281511Medicare ID - Type Unspecified