Provider Demographics
NPI:1841293487
Name:KING, LEWIS ROY (MD)
Entity type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:ROY
Last Name:KING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:602 TITUS ST STE 140
Mailing Address - Street 2:
Mailing Address - City:GILMER
Mailing Address - State:TX
Mailing Address - Zip Code:75644-1780
Mailing Address - Country:US
Mailing Address - Phone:903-843-2202
Mailing Address - Fax:903-843-2212
Practice Address - Street 1:602 TITUS ST
Practice Address - Street 2:SUITE 140
Practice Address - City:GILMER
Practice Address - State:TX
Practice Address - Zip Code:75644-1700
Practice Address - Country:US
Practice Address - Phone:903-843-2202
Practice Address - Fax:903-843-2212
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ2129207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138347319Medicaid
TX138347318Medicaid
TXTXB147826Medicare PIN