Provider Demographics
NPI:1538488846
Name:LEWJACK ASSISTING LLC
Entity Type:Organization
Organization Name:LEWJACK ASSISTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:LEWIS
Authorized Official - Middle Name:JACKSON
Authorized Official - Last Name:DORRANCE
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:561-743-7030
Mailing Address - Street 1:4416 NICOLE CIR
Mailing Address - Street 2:
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-2574
Mailing Address - Country:US
Mailing Address - Phone:561-743-7030
Mailing Address - Fax:561-743-7030
Practice Address - Street 1:4416 NICOLE CIR
Practice Address - Street 2:
Practice Address - City:TEQUESTA
Practice Address - State:FL
Practice Address - Zip Code:33469-2574
Practice Address - Country:US
Practice Address - Phone:561-743-7030
Practice Address - Fax:561-743-7030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-26
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA 2335363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty