MEDICARE: LEW BRADLEY DISNEY MD

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	A49362	CA

General Provider Information

NPI Number	:	1154307296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEW BRADLEY DISNEY MD

Provider Business Mailing Address
First Line	:	255 E BONITA AVE
Second Line	:	BUILDING #9
City	:	POMONA
State	:	CA
Zip	:	91767-1923
Country	:	US
Telephone Number	:	909-450-0369
Fax Number	:	909-450-0366

Provider Business Practice Location Address
First Line	:	255 E BONITA AVE
Second Line	:	BUILDING #9
City	:	POMONA
State	:	CA
Zip	:	91767-1923
Country	:	US
Telephone Number	:	909-450-0369
Fax Number	:	909-450-0366

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

Provider Enumeration Date	:	12/20/2005
Last Update Date	:	06/15/2010

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