Provider Demographics
NPI:1912954835
Name:EWING, WILLIE B (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIE
Middle Name:B
Last Name:EWING
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1524 W LACEY BLVD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:HANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:93230-5965
Mailing Address - Country:US
Mailing Address - Phone:559-583-4697
Mailing Address - Fax:559-583-4600
Practice Address - Street 1:784 N LEMOORE AVE
Practice Address - Street 2:
Practice Address - City:LEMOORE
Practice Address - State:CA
Practice Address - Zip Code:93245-2329
Practice Address - Country:US
Practice Address - Phone:559-924-5358
Practice Address - Fax:559-924-8410
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2012-11-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAC38731207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA36992Medicare UPIN
CA00C387311Medicare ID - Type Unspecified
A0744ZMedicare PIN