1760657555 NPI number — WILLIAM R. LEWIS, M.D., INC

Table of content: (NPI 1760657555)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760657555 NPI number — WILLIAM R. LEWIS, M.D., INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAM R. LEWIS, M.D., INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760657555
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1483
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PEBBLE BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93953-1483
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-624-8713
Provider Business Mailing Address Fax Number:
831-624-5751

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
757 PACIFIC ST STE D1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTEREY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93940-2819
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-624-8713
Provider Business Practice Location Address Fax Number:
831-624-5751
Provider Enumeration Date:
04/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LEWIS
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
831-624-8713

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , with the licence number:  C232610 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ZZZ07386Z . This is a "MEDICARE PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1376636233 . This is a "TYPE 1 - INDIVIDUAL NPI NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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