Provider Demographics
NPI:1962002592
Name:LEWIS, DUANE
Entity Type:Individual
Prefix:DR
First Name:DUANE
Middle Name:
Last Name:LEWIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5465 BRITTANY LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:TX
Mailing Address - Zip Code:75462-6021
Mailing Address - Country:US
Mailing Address - Phone:903-517-3951
Mailing Address - Fax:
Practice Address - Street 1:3855 LAMAR AVE
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75462
Practice Address - Country:US
Practice Address - Phone:903-785-8734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-01
Last Update Date:2020-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX32377183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist