Provider Demographics
NPI:1184972994
Name:LEWIS, HARRISON III (PA-C)
Entity type:Individual
Prefix:DR
First Name:HARRISON
Middle Name:
Last Name:LEWIS
Suffix:III
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4340 FISHER RD
Mailing Address - Street 2:
Mailing Address - City:PROSPER
Mailing Address - State:TX
Mailing Address - Zip Code:75078-2602
Mailing Address - Country:US
Mailing Address - Phone:214-415-9334
Mailing Address - Fax:
Practice Address - Street 1:4340 FISHER RD
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-2602
Practice Address - Country:US
Practice Address - Phone:972-608-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-28
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03127363AM0700X, 363AM0700X
IL085007217363A00000X
MAPA6563363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX342529001Medicaid
TX391698YMAFOtherMEDICARE