Provider Demographics
NPI:1831135912
Name:LEWIS, PERRY CARTER (MD)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:CARTER
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 1:701 E MARSHALL AVE
Mailing Address - Street 2:STE. 200
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-5573
Mailing Address - Country:US
Mailing Address - Phone:903-236-2222
Mailing Address - Fax:
Practice Address - Street 1:701 E MARSHALL AVE
Practice Address - Street 2:STE. 200
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-5573
Practice Address - Country:US
Practice Address - Phone:903-236-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2011-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8210207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX126500107Medicaid
TX126500107Medicaid
TXE69977Medicare UPIN