Jerry Lane Lewis, PA
Individual provider Active NPI Medical Physician Assistant · Planada, CA
NPI 1801879341 · NPPES record last updated Mar 7, 2023
Key facts
- NPI
- 1801879341
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- PA11479 (CA)
- Practice address
- 9235 E Broadway St
Planada, CA 95365-8088 - Phone
- (209) 382-0253
- Fax
- (209) 382-2110
- NPI assigned
- Nov 29, 2005
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA11479 | CA | Yes |
Addresses
Primary practice location
9235 E Broadway St
Planada, CA 95365-8088
Mailing address
737 W Childs Ave
Merced, CA 95340-6805
Phone (209) 383-1848
Other providers in Planada, CA
- Golden Valley Health Centers
- Golden Valley Health Centers
- Golden Valley Health Centers
- Stephanie D Hernandez
- John Robert Lee
- Eva Lomeli
- Ronald A. Marquez
- Ramaa Maruthachalam
- Shirley Ann Perido Pasia
- Planada Elementary School District
All providers in Planada, CA · Medical Physician Assistant in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 7, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.