Provider Demographics
NPI:1285722983
Name:LEWIS, LISA E (MD)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:E
Last Name:LEWIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:EHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:230 N RUFE SNOW DR
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-4226
Mailing Address - Country:US
Mailing Address - Phone:817-337-5503
Mailing Address - Fax:817-337-0110
Practice Address - Street 1:6618 FOSSIL BLUFF DR
Practice Address - Street 2:STE 116
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76137-7533
Practice Address - Country:US
Practice Address - Phone:817-847-6420
Practice Address - Fax:817-847-6412
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2009-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0730208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
1164541967OtherFORT WORTH GROUP NPI
TX047946102Medicaid
1710006598OtherKELLER GROUP NPI
TX0046KVOtherBCBS GROUP
TX8K6666OtherBCBS
G27995Medicare UPIN