Provider Demographics
NPI:1720768294
Name:LEWIS, BRYAN (CSFA)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:
Last Name:LEWIS
Suffix:
Gender:M
Credentials:CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 TIMBER RIDGE ST NE APT 257
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97322-7441
Mailing Address - Country:US
Mailing Address - Phone:704-315-1697
Mailing Address - Fax:
Practice Address - Street 1:SAMARITAN ALBANY GENERAL HOSPITAL
Practice Address - Street 2:1046 6TH AVE SW
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321
Practice Address - Country:US
Practice Address - Phone:541-812-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-20
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL211229246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant