Provider Demographics
NPI:1831635168
Name:EWENS, DONALD GORDON III (PA-C)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:GORDON
Last Name:EWENS
Suffix:III
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:7331 SHELBY PL APT 141
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-5914
Mailing Address - Country:US
Mailing Address - Phone:909-522-7219
Mailing Address - Fax:
Practice Address - Street 1:26520 CACTUS AVE
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-3927
Practice Address - Country:US
Practice Address - Phone:951-486-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-10
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA54142363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical