Individual
BRANDON J. LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
504 N CARRIER PKWY, GRAND PRAIRIE, TX 75050-5428
(972) 263-7042
(972) 263-7046
Mailing address
504 N CARRIER PKWY, GRAND PRAIRIE, TX 75050-5428
(972) 263-7042
(972) 263-7046
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
1574
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
161998302
—
TX
01
—
8U9330
BCBS
TX
01
—
P00820670
GROUP MEMBER INDIVIDUAL RRM PTAN #
TX
Enumeration date
08/01/2005
Last updated
08/16/2010
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