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General NPI Number Information
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NPI Number | 1013168491
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Entity Type | Organization
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Legal Business Name | B. DOUGLAS LEWIS, M.D., A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 10/03/2008
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Last Update Date | 10/03/2008
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Provider Practice Location Address
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Address Line | 3351 EL CAMINO REAL STE 205
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City | ATHERTON
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State | CA
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Zip | 94027-3864
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Country | US
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Telephone | 650-364-3600
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Fax | 650-364-3609
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Provider Business Mailing Address
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Address Line | 3351 EL CAMINO REAL STE 205
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City | ATHERTON
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State | CA
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Zip | 94027-3864
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Country | US
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Telephone | 650-364-3600
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Fax | 650-364-3609
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Authorized Official
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Title or Position | PRESIDENT
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Name | BRIAN DOUGLAS LEWIS
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Credential | M.D.
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Telephone | 650-364-3600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number | G48356
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | G48356
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License Number State | CA
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