Provider Demographics
NPI:1760657555
Name:WILLIAM R. LEWIS, M.D., INC
Entity Type:Organization
Organization Name:WILLIAM R. LEWIS, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:831-624-8713
Mailing Address - Street 1:PO BOX 1483
Mailing Address - Street 2:
Mailing Address - City:PEBBLE BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93953-1483
Mailing Address - Country:US
Mailing Address - Phone:831-624-8713
Mailing Address - Fax:831-624-5751
Practice Address - Street 1:757 PACIFIC ST STE D1
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-2819
Practice Address - Country:US
Practice Address - Phone:831-624-8713
Practice Address - Fax:831-624-5751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-23
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC232610207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ07386ZOtherMEDICARE PTAN
CA1376636233OtherTYPE 1 - INDIVIDUAL NPI NUMBER