Provider Demographics
NPI:1225592967
Name:LEWIS, RONALD A
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:A
Last Name:LEWIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3521 MARSHALL CIR
Mailing Address - Street 2:
Mailing Address - City:VAN BUREN
Mailing Address - State:AR
Mailing Address - Zip Code:72956-8846
Mailing Address - Country:US
Mailing Address - Phone:909-855-6181
Mailing Address - Fax:
Practice Address - Street 1:3521 MARSHALL CIR
Practice Address - Street 2:
Practice Address - City:VAN BUREN
Practice Address - State:AR
Practice Address - Zip Code:72956-8846
Practice Address - Country:US
Practice Address - Phone:909-855-6181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-28
Last Update Date:2019-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator