MEDICARE: DR. STEPHEN B. LEWIS M.D.

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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	G20175	CA
2	207R00000X	Internal Medicine Physician	G20175	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00G201750	OTHER	CA	MEDICARE PTAN

General Provider Information

NPI Number	:	1366460594
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN B. LEWIS M.D.

Provider Business Mailing Address
First Line	:	2425 EAST ST
Second Line	:	#15
City	:	CONCORD
State	:	CA
Zip	:	94520-1928
Country	:	US
Telephone Number	:	925-682-9232
Fax Number	:	925-676-2198

Provider Business Practice Location Address
First Line	:	2425 EAST ST
Second Line	:	#15
City	:	CONCORD
State	:	CA
Zip	:	94520-1928
Country	:	US
Telephone Number	:	925-682-9232
Fax Number	:	925-676-2198

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	09/22/2016

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