Provider Demographics
NPI:1417923558
Name:LEWIS, MARSHALL S (MD)
Entity Type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:S
Last Name:LEWIS
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 1:2619 F ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-1815
Mailing Address - Country:US
Mailing Address - Phone:661-861-0011
Mailing Address - Fax:661-861-9400
Practice Address - Street 1:2619 F ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301
Practice Address - Country:US
Practice Address - Phone:661-861-0011
Practice Address - Fax:661-861-9400
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2015-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG28242207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA43662Medicare UPIN