Provider Demographics
NPI:1881661528
Name:LEWIS, RANDALL S (MD)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:S
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 51270
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-0905
Mailing Address - Country:US
Mailing Address - Phone:541-654-1545
Mailing Address - Fax:541-687-6154
Practice Address - Street 1:2121 KIMBERLY CIR
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-5821
Practice Address - Country:US
Practice Address - Phone:541-654-1545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-01
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD10258207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR242065Medicaid
D72810Medicare UPIN
ORRR PTAN 160028187Medicare PIN
OR242065Medicaid