Provider Demographics
NPI:1871524488
Name:EDWARDS, LEWIS TODD
Entity type:Individual
Prefix:
First Name:LEWIS
Middle Name:TODD
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 REPUBLIC PKWY
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6917
Mailing Address - Country:US
Mailing Address - Phone:972-279-7575
Mailing Address - Fax:972-270-0197
Practice Address - Street 1:1650 REPUBLIC PKWY
Practice Address - Street 2:SUITE 150
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6916
Practice Address - Country:US
Practice Address - Phone:972-279-7575
Practice Address - Fax:972-270-0197
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2895207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXG99784Medicare UPIN
TX88172NMedicare ID - Type Unspecified