Organization
A RAY LEWIS DO PA
Active
Other names
East Fort Worth Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ADOLPHUS RAY LEWIS DO (OWNER/PHYSICIAN)
(817) 534-1010
Entity
Organization
Contact information
Practice address
4732 E. LANCASTER ST, FORT WORTH, TX 76103-3836
(817) 534-1010
(817) 413-0300
Mailing address
4732 E LANCASTER ST, FORT WORTH, TX 76103-3836
(817) 534-1010
(817) 413-0300
Taxonomy
Speciality
Code
Description
License number
State
207QG0300X
Geriatric Medicine (Family Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0064QF
BLUE CROSS BLUE SHIELD
TX
01
—
080012814
PALMETTO GBA
TX
Enumeration date
01/30/2006
Last updated
01/31/2008
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