| Organization Name: | B. DOUGLAS LEWIS, M.D., A PROFESSIONAL CORPORATION |
| NPI Number: | 1013168491 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | BRIAN DOUGLAS LEWIS (PRESIDENT) |
| Mailing Address: | 3351 El Camino Real Ste 205 Atherton |
| State: | CA US |
| Postal Code: | 940273864 |
| Phone Number: | 6503643600 |
| Fax Number: | 6503643609 |
| NPI Enumeration Date: | 10/03/2008 |
| NPI Last Update Date: | 10/03/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QR0200X |
| License Number: | G48356 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Radiology |
| Taxonomy Definition: | |