Healthcare Provider Details

I. General information

NPI: 1225019110
Provider Name (Legal Business Name): DREW D LEWIS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 12/13/2023
Certification Date: 12/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1739 COLORADO AVE
TURLOCK CA
95382-2714
US

IV. Provider business mailing address

PO BOX 1462
HUGHSON CA
95326-1462
US

V. Phone/Fax

Practice location:
  • Phone: 209-448-3000
  • Fax: 209-442-4116
Mailing address:
  • Phone: 515-271-1722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number3832
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number21540
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: