Provider Demographics
NPI:1871552869
Name:LEWIS, CHAD E (MD)
Entity type:Individual
Prefix:DR
First Name:CHAD
Middle Name:E
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 1:2200 4TH AVE # 207
Mailing Address - Street 2:
Mailing Address - City:CANYON
Mailing Address - State:TX
Mailing Address - Zip Code:79015-4030
Mailing Address - Country:US
Mailing Address - Phone:806-452-7221
Mailing Address - Fax:806-452-7231
Practice Address - Street 1:1617 4TH AVE
Practice Address - Street 2:
Practice Address - City:CANYON
Practice Address - State:TX
Practice Address - Zip Code:79015-3824
Practice Address - Country:US
Practice Address - Phone:806-452-7221
Practice Address - Fax:806-452-7231
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-20
Last Update Date:2020-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD203738208600000X, 208C00000X
TXM0150208600000X, 208C00000X
TN49193208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1969552Medicaid
LA2119893Medicaid
TN103I285412Medicare PIN
TX370567YKQPMedicare PIN
LA4P316DP56Medicare UPIN