Provider Demographics
NPI:1346202975
Name:LEWTON, ZACHARY R (MD)
Entity Type:Individual
Prefix:
First Name:ZACHARY
Middle Name:R
Last Name:LEWTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1194 MONTGOMERY DR
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95405-4802
Mailing Address - Country:US
Mailing Address - Phone:707-303-1714
Mailing Address - Fax:
Practice Address - Street 1:1194 MONTGOMERY DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95405-4802
Practice Address - Country:US
Practice Address - Phone:707-303-1714
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2021-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-0846452084N0400X
CAC559882084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00180585OtherRAILROAD MEDICARE
OH108873OtherKAISER
OH2534832Medicaid
OH000000341686OtherANTHEM BLUECROSS/BLUESHEI
OH341097565ZLOtherSUMMACARE
OH729710OtherBUCKEYE COMMUNITY HEALTH
OHP00180585OtherRAILROAD MEDICARE
OHLE4150591Medicare PIN