Provider Demographics
NPI:1730316696
Name:LEWIS, ALAN M (PA-C)
Entity type:Individual
Prefix:MR
First Name:ALAN
Middle Name:M
Last Name:LEWIS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 S MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:BREMOND
Mailing Address - State:TX
Mailing Address - Zip Code:76629-2359
Mailing Address - Country:US
Mailing Address - Phone:254-746-7264
Mailing Address - Fax:547-465-0962
Practice Address - Street 1:201 S MAIN STREET
Practice Address - Street 2:
Practice Address - City:BREMOND
Practice Address - State:TX
Practice Address - Zip Code:76629
Practice Address - Country:US
Practice Address - Phone:254-746-7264
Practice Address - Fax:254-746-5096
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06278363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB111350Medicare PIN