Provider Demographics
NPI:1386750933
Name:CLARKE, LEWIS K (MD)
Entity type:Individual
Prefix:
First Name:LEWIS
Middle Name:K
Last Name:CLARKE
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:PO BOX 57995
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:TX
Mailing Address - Zip Code:77598-7995
Mailing Address - Country:US
Mailing Address - Phone:281-332-1755
Mailing Address - Fax:281-332-2737
Practice Address - Street 1:17448 HIGHWAY 3
Practice Address - Street 2:SUITE 130
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-4197
Practice Address - Country:US
Practice Address - Phone:281-332-1755
Practice Address - Fax:281-332-2737
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2305208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE42586Medicare UPIN
TX88320FMedicare PIN