Provider Demographics
NPI:1952392144
Name:LEWIS, STANLEY T (MD)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:T
Last Name:LEWIS
Suffix:
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 1:6800 WEST LOOP S
Mailing Address - Street 2:SUITE 560
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-4528
Mailing Address - Country:US
Mailing Address - Phone:713-778-1300
Mailing Address - Fax:713-778-0827
Practice Address - Street 1:6800 WEST LOOP S
Practice Address - Street 2:SUITE 560
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-4528
Practice Address - Country:US
Practice Address - Phone:713-778-1300
Practice Address - Fax:713-778-0827
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2739207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101837603Medicaid
TX008365Medicare ID - Type Unspecified
TX101837603Medicaid