Provider Demographics
NPI:1770541559
Name:WARE, LEWIS L JR (MD)
Entity type:Individual
Prefix:
First Name:LEWIS
Middle Name:L
Last Name:WARE
Suffix:JR
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 1:6550 FANNIN ST
Mailing Address - Street 2:SUITE 749
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2717
Mailing Address - Country:US
Mailing Address - Phone:713-441-7465
Mailing Address - Fax:
Practice Address - Street 1:6550 FANNIN ST
Practice Address - Street 2:SUITE 749
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2717
Practice Address - Country:US
Practice Address - Phone:713-441-7465
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE11712085R0202X
MO1141572085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX132345311Medicaid
TX132345309Medicaid
TX132345305Medicaid
TX132345312Medicaid
TX1770541559OtherBLUE CROSS BLUE SHIELD
TX132345310Medicaid
C23170Medicare UPIN
TX132345312Medicaid
TX132345310Medicaid
TX132345309Medicaid
TX8L26292Medicare PIN
TX8K6805Medicare PIN
TX82R045Medicare PIN