MEDICARE: DR. JIM LEWIS STORY M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician	C9498	TX

General Provider Information

NPI Number	:	1558686758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JIM LEWIS STORY M.D.

Provider Business Mailing Address
First Line	:	3135 STONEHAVEN DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-4042
Country	:	US
Telephone Number	:	210-344-9082
Fax Number	:	210-344-3633

Provider Business Practice Location Address
First Line	:	3135 STONEHAVEN DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78230-4042
Country	:	US
Telephone Number	:	210-344-9082
Fax Number	:	210-344-3633

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2010
Last Update Date	:	03/30/2010

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