Provider Demographics
NPI:1750553491
Name:LEWIS, ANNE MEREDITH (MD)
Entity type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:MEREDITH
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 1:12221 MERIT DR.
Mailing Address - Street 2:STE 1500
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251
Mailing Address - Country:US
Mailing Address - Phone:319-331-9508
Mailing Address - Fax:410-955-0834
Practice Address - Street 1:7777 FOREST LANE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230
Practice Address - Country:US
Practice Address - Phone:319-331-9508
Practice Address - Fax:410-955-0834
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-01
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD4083208600000X
TXP7797207P00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX334709801Medicaid
TX334709802Medicaid
TX348616YLLVMedicare PIN
TX348616YKN5Medicare PIN