Basic Information
| Provider Information | |||||||||
| NPI: | 1396728804 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | ROY | ||||||||
| MiddleName: | SHELDON | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 149 PLANTATION RIDGE DR. | ||||||||
| Address2: | SUITE 190 | ||||||||
| City: | MOORESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281179174 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046580595 | ||||||||
| FaxNumber: | 7046580916 | ||||||||
| Practice Location | |||||||||
| Address1: | 149 PLANTATION RIDGE DR. | ||||||||
| Address2: | SUITE 190 | ||||||||
| City: | MOORESVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 281179174 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7046580595 | ||||||||
| FaxNumber: | 7046580916 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/29/2005 | ||||||||
| LastUpdateDate: | 11/17/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 2011-01689 | NC | Y | Allopathic & Osteopathic Physicians | Otolaryngology |
ID Information
| ID | Type | State | Issuer | Description | 1699C | 01 | NC | BCBSNC | OTHER | P01650118 | 01 | NC | MEDICARE-RAILROAD | OTHER | 6239215 | 01 | CIGNA | OTHER | BL4829745 | 01 | DEA | OTHER | 1216263 | 01 | SC | WELLCARE OF SC | OTHER | 117783401 | 05 | TX | MEDICAID | Q0168A | 05 | SC | MEDICAID |