Individual
JACK LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
201 REINHARDT DR, LAFAYETTE, LA 70506-4252
(800) 563-8000
Mailing address
913 PINECONE DR, MODESTO, CA 95351-1878
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
01/14/2019
Last updated
01/14/2019
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