Provider Demographics
NPI:1225019110
Name:LEWIS, DREW D (DO)
Entity Type:Individual
Prefix:DR
First Name:DREW
Middle Name:D
Last Name:LEWIS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1462
Mailing Address - Street 2:
Mailing Address - City:HUGHSON
Mailing Address - State:CA
Mailing Address - Zip Code:95326-1462
Mailing Address - Country:US
Mailing Address - Phone:515-271-1722
Mailing Address - Fax:
Practice Address - Street 1:1739 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2714
Practice Address - Country:US
Practice Address - Phone:209-448-3000
Practice Address - Fax:209-442-4116
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3832208100000X
CA215402081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARES000Medicare UPIN