Healthcare Provider Details

I. General information

NPI: 1033295282
Provider Name (Legal Business Name): DONALD R. LEWIS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 03/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E RIVER PARK CIR SUITE 460
FRESNO CA
93720-1571
US

IV. Provider business mailing address

205 E RIVER PARK CIR SUITE 460
FRESNO CA
93720-1571
US

V. Phone/Fax

Practice location:
  • Phone: 559-261-4500
  • Fax: 559-261-4500
Mailing address:
  • Phone: 559-261-4500
  • Fax: 559-261-4500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG39078
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: