Provider Demographics
NPI:1508184409
Name:LEWIS, HARRY EUGENE JR (MD)
Entity Type:Individual
Prefix:
First Name:HARRY
Middle Name:EUGENE
Last Name:LEWIS
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 241
Mailing Address - Street 2:8400 FLYNN CREEK RD
Mailing Address - City:COMPTCHE
Mailing Address - State:CA
Mailing Address - Zip Code:95427-0241
Mailing Address - Country:US
Mailing Address - Phone:707-937-4397
Mailing Address - Fax:707-937-4397
Practice Address - Street 1:8400 FLYNN CREEK RD
Practice Address - Street 2:
Practice Address - City:COMPTCHE
Practice Address - State:CA
Practice Address - Zip Code:95427-0241
Practice Address - Country:US
Practice Address - Phone:707-937-4397
Practice Address - Fax:707-937-4397
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-17
Last Update Date:2010-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG48900208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice