Healthcare Provider Details

I. General information

NPI: 1073584173
Provider Name (Legal Business Name): JAMIE BARTON LEWIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/28/2006
Last Update Date: 01/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15464 GOLDENWEST ST
WESTMINSTER CA
92683-6149
US

IV. Provider business mailing address

15464 GOLDENWEST ST
WESTMINSTER CA
92683-6149
US

V. Phone/Fax

Practice location:
  • Phone: 714-891-9008
  • Fax: 714-893-2239
Mailing address:
  • Phone: 714-891-9008
  • Fax: 714-893-2239

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG34787
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG34787
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: