Provider Demographics
NPI:1366460594
Name:LEWIS, STEPHEN B (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:B
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2425 EAST ST
Mailing Address - Street 2:#15
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-1928
Mailing Address - Country:US
Mailing Address - Phone:925-682-9232
Mailing Address - Fax:925-676-2198
Practice Address - Street 1:2425 EAST ST
Practice Address - Street 2:#15
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-1928
Practice Address - Country:US
Practice Address - Phone:925-682-9232
Practice Address - Fax:925-676-2198
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2016-09-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG20175207RE0101X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G201750OtherMEDICARE PTAN