Provider Demographics
NPI:1952608382
Name:LEWIS, BRANDON R
Entity Type:Individual
Prefix:
First Name:BRANDON
Middle Name:R
Last Name:LEWIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26222 RANCH ROAD 12
Mailing Address - Street 2:
Mailing Address - City:DRIPPING SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:78620-4903
Mailing Address - Country:US
Mailing Address - Phone:512-858-0300
Mailing Address - Fax:512-858-2714
Practice Address - Street 1:15577 SW 116TH AVE
Practice Address - Street 2:
Practice Address - City:KING CITY
Practice Address - State:OR
Practice Address - Zip Code:97224-2653
Practice Address - Country:US
Practice Address - Phone:503-968-6445
Practice Address - Fax:503-968-8968
Is Sole Proprietor?:No
Enumeration Date:2011-02-21
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORHAS-P-127970237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist