Provider Demographics
NPI:1841284866
Name:LEWIN, MARCIAL GOMEZ (MD)
Entity type:Individual
Prefix:MR
First Name:MARCIAL
Middle Name:GOMEZ
Last Name:LEWIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:342 RICHLAND WEST CIR
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-7919
Mailing Address - Country:US
Mailing Address - Phone:254-772-6760
Mailing Address - Fax:254-772-1035
Practice Address - Street 1:342 RICHLAND WEST CIR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-7919
Practice Address - Country:US
Practice Address - Phone:254-772-6760
Practice Address - Fax:254-772-1035
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-06
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXE8035207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115842003Medicaid
C18386Medicare UPIN
TX115842003Medicaid