Provider Demographics
NPI:1932764297
Name:LEWIS, JACOB OGDEN (PA-S)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:OGDEN
Last Name:LEWIS
Suffix:
Gender:M
Credentials:PA-S
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Other - Credentials:
Mailing Address - Street 1:PO BOX 661
Mailing Address - Street 2:
Mailing Address - City:LOVELOCK
Mailing Address - State:NV
Mailing Address - Zip Code:89419-0661
Mailing Address - Country:US
Mailing Address - Phone:775-273-2918
Mailing Address - Fax:775-273-5095
Practice Address - Street 1:850 6TH ST
Practice Address - Street 2:
Practice Address - City:LOVELOCK
Practice Address - State:NV
Practice Address - Zip Code:89419-8020
Practice Address - Country:US
Practice Address - Phone:775-273-2918
Practice Address - Fax:775-273-5095
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2019-09-24
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant