Provider Demographics
NPI:1346414703
Name:LEWIS, RANDALL EUGENE
Entity Type:Individual
Prefix:MR
First Name:RANDALL
Middle Name:EUGENE
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 1:10531 PACES AVE
Mailing Address - Street 2:#924
Mailing Address - City:MATTHEWS
Mailing Address - State:NC
Mailing Address - Zip Code:28105-2719
Mailing Address - Country:US
Mailing Address - Phone:843-575-3892
Mailing Address - Fax:
Practice Address - Street 1:10531 PACES AVE
Practice Address - Street 2:#924
Practice Address - City:MATTHEWS
Practice Address - State:NC
Practice Address - Zip Code:28105-2719
Practice Address - Country:US
Practice Address - Phone:843-575-3892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant