Provider Demographics
NPI:1528259173
Name:LEWIS, RYAN C (MD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:C
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 1:2810 HARDIN BLVD
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070
Mailing Address - Country:US
Mailing Address - Phone:972-548-7277
Mailing Address - Fax:972-547-0038
Practice Address - Street 1:2810 HARDIN BLVD
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070
Practice Address - Country:US
Practice Address - Phone:972-548-7277
Practice Address - Fax:972-547-0038
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2015-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0923207Q00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8EG805OtherBLUE CROSS BLUE SHIELD OF TEXAS
TX195643515Medicaid
TXP00816303OtherRAILROAD
TX1528259173OtherTRICARE SOUTH
TX195643515Medicaid
TX8L0359Medicare PIN
TX278503ZG6FMedicare PIN