Provider Demographics
NPI:1003005679
Name:DOUGLAS-LEWIS, YVETTE RENEE
Entity Type:Individual
Prefix:DR
First Name:YVETTE
Middle Name:RENEE
Last Name:DOUGLAS-LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 CHRISTMAS RD
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27589-8723
Mailing Address - Country:US
Mailing Address - Phone:252-257-0372
Mailing Address - Fax:
Practice Address - Street 1:163 CHRISTMAS RD
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:NC
Practice Address - Zip Code:27589-8723
Practice Address - Country:US
Practice Address - Phone:252-257-0372
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-19
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9601595207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7910404Medicaid
NC2024954Medicare PIN
NCG56065Medicare UPIN