Provider Demographics
NPI:1720077811
Name:LEWI, JACK EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:EDWARD
Last Name:LEWI
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3551 ROGER BROOKE DRIVE -MCHE-MDE
Mailing Address - Street 2:BROOKE ARMY MEDICAL CENTER
Mailing Address - City:FORT SAM HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:78234-6200
Mailing Address - Country:US
Mailing Address - Phone:210-916-8589
Mailing Address - Fax:210-916-3877
Practice Address - Street 1:3551 ROGER BROOKE DR
Practice Address - Street 2:ATTN: MCHE-MDE
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234-4504
Practice Address - Country:US
Practice Address - Phone:210-916-8589
Practice Address - Fax:210-916-3877
Is Sole Proprietor?:No
Enumeration Date:2005-10-20
Last Update Date:2013-06-05
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Provider Licenses
StateLicense IDTaxonomies
TXK0336207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism