Healthcare Provider Details

I. General information

NPI: 1508293473
Provider Name (Legal Business Name): ERIC A LEWIS A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2013
Last Update Date: 10/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 BRIGHTON WAY SUITE 201
BEVERLY HILLS CA
90210-4714
US

IV. Provider business mailing address

9400 BRIGHTON WAY SUITE 201
BEVERLY HILLS CA
90210-4714
US

V. Phone/Fax

Practice location:
  • Phone: 310-289-9700
  • Fax:
Mailing address:
  • Phone: 310-289-9700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License Number
License Number State

VIII. Authorized Official

Name: ERIC A LEWIS
Title or Position: PHYSICIAN
Credential: M.D.
Phone: 310-289-9700