Provider Demographics
NPI:1902644131
Name:LEWIS, FARRON LATRAZ JR
Entity type:Individual
Prefix:
First Name:FARRON
Middle Name:LATRAZ
Last Name:LEWIS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30193 LAZY K DR
Mailing Address - Street 2:
Mailing Address - City:LACOMBE
Mailing Address - State:LA
Mailing Address - Zip Code:70445-4021
Mailing Address - Country:US
Mailing Address - Phone:318-437-9344
Mailing Address - Fax:
Practice Address - Street 1:30193 LAZY K DR
Practice Address - Street 2:
Practice Address - City:LACOMBE
Practice Address - State:LA
Practice Address - Zip Code:70445-4021
Practice Address - Country:US
Practice Address - Phone:318-437-9344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-20
Last Update Date:2024-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA012408886343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)