Provider Demographics
NPI:1194768077
Name:LEW, CLARKE R (MD)
Entity type:Individual
Prefix:
First Name:CLARKE
Middle Name:R
Last Name:LEW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:751 S WEIR CANYON RD
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92808-1962
Mailing Address - Country:US
Mailing Address - Phone:714-453-0120
Mailing Address - Fax:714-453-0138
Practice Address - Street 1:751 S WEIR CANYON RD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92808-1962
Practice Address - Country:US
Practice Address - Phone:714-453-0120
Practice Address - Fax:714-453-0138
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA54668207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA54668EOtherMEDICARE PTAN