Provider Demographics
NPI:1417938382
Name:BEAN, LEWIS C (MD)
Entity Type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:C
Last Name:BEAN
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 1:1600 W EAU GALLIE BLVD SUITE 102
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935
Mailing Address - Country:US
Mailing Address - Phone:321-726-0007
Mailing Address - Fax:321-622-6231
Practice Address - Street 1:1600 W EAU GALLIE BLVD SUITE 102
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935
Practice Address - Country:US
Practice Address - Phone:321-726-0007
Practice Address - Fax:321-622-6231
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2018-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME85479207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL264822900Medicaid
FL93944Medicare ID - Type Unspecified
FL264822900Medicaid