Provider Demographics
NPI:1831120021
Name:LEWIS, MELBA FLORINE (MD)
Entity Type:Individual
Prefix:DR
First Name:MELBA
Middle Name:FLORINE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 BARTON LEE DR, #410
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4407 BEE CAVES RD
Practice Address - Street 2:1-112
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746
Practice Address - Country:US
Practice Address - Phone:512-328-4999
Practice Address - Fax:512-328-4979
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2014-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2558207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2290397OtherAETNA PROVIDER
TX0019DKOtherBCBS PROVIDER
TX89190NMedicare ID - Type Unspecified
TX0019DKOtherBCBS PROVIDER