MEDICARE: STEWART A LEWIS DO RPH INC

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	207LP2900X	Pain Medicine (Anesthesiology) Physician	20A13858	CA

General Provider Information

NPI Number	:	1013422633
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STEWART A LEWIS DO RPH INC

Provider Business Mailing Address
First Line	:	1281 9TH AVE UNIT 3009
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-4676
Country	:	US
Telephone Number	:	619-804-0461
Fax Number	:	619-795-6606

Provider Business Practice Location Address
First Line	:	1281 9TH AVE UNIT 3009
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-4676
Country	:	US
Telephone Number	:	619-804-0461
Fax Number	:	619-795-6606

Authorized Official
Title or Position	:	OWNER
Name	:	DR. STEWART A LEWIS
Credential	:	MD
Telephone Number	:	661-809-6527

Provider Enumeration Date	:	12/05/2017
Last Update Date	:	12/05/2017

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