Provider Demographics
NPI:1962505206
Name:LEWIS, DARRON (MD)
Entity Type:Individual
Prefix:
First Name:DARRON
Middle Name:
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 1:1700 SE HILLMOOR DR STE 407
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34952-7561
Mailing Address - Country:US
Mailing Address - Phone:772-335-9600
Mailing Address - Fax:772-398-7971
Practice Address - Street 1:1700 SE HILLMOOR DR STE 407
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7561
Practice Address - Country:US
Practice Address - Phone:772-335-9600
Practice Address - Fax:772-398-7971
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19901207R00000X
FLME122135207RC0000X, 207RI0011X, 207R00000X
KY39837207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100133560Medicaid
KYP00872492Medicare PIN
MS512I110194Medicare PIN
KYP400025994Medicare Oscar/Certification