Provider Demographics
NPI:1033295282
Name:LEWIS, DONALD R JR (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:R
Last Name:LEWIS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 E RIVER PARK CIR
Mailing Address - Street 2:SUITE 460
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-1571
Mailing Address - Country:US
Mailing Address - Phone:559-261-4500
Mailing Address - Fax:559-261-4500
Practice Address - Street 1:205 E RIVER PARK CIR
Practice Address - Street 2:SUITE 460
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-1571
Practice Address - Country:US
Practice Address - Phone:559-261-4500
Practice Address - Fax:559-261-4500
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-31
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39078174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA47696Medicare PIN
CAA47696Medicare UPIN