Basic Information
| Provider Information | |||||||||
| NPI: | 1811067317 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EWING | ||||||||
| FirstName: | HAROLD | ||||||||
| MiddleName: | JESSE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5680 DRAGON SPRINGS RD | ||||||||
| Address2: | |||||||||
| City: | PLACERVILLE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956679367 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5306729648 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6651 MADISON AVE | ||||||||
| Address2: | |||||||||
| City: | CARMICHAEL | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956080602 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9169651111 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2006 | ||||||||
| LastUpdateDate: | 11/19/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 0PA129670 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.