MEDICARE: GREGORY R. LEWIS M.D., F.A.A.F.P.

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	207Q00000X	Family Medicine Physician	A142894	CA
2	207Q00000X	Family Medicine Physician	23369	AZ
3	207Q00000X	Family Medicine Physician	G142894	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225078363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY R. LEWIS M.D., F.A.A.F.P.

Provider Business Mailing Address
First Line	:	PO BOX 31309
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90031-0309
Country	:	US
Telephone Number	:	213-744-0801
Fax Number	:

Provider Business Practice Location Address
First Line	:	1400 S GRAND AVE
Second Line	:	SUITE 101
City	:	LOS ANGELES
State	:	CA
Zip	:	90015-3048
Country	:	US
Telephone Number	:	213-744-0801
Fax Number	:

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

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	07/28/2021

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Directions to “ GREGORY R. LEWIS M.D., F.A.A.F.P.” Practice Location

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