Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | G21317 | CA |
N | 207ND0101X | MOHS-Micrographic Surgeon | G21317 | CA |
N | 207ND0900X | Dermatopathologist | G21317 | CA |
N | 207NS0135X | Procedural Dermatology | G21317 | CA |
NPI | 1477650372 |
---|---|
Provider Name | Alexander Lewis III |
First Address | Walnut Creek, CA 94596 |
Second Address | Walnut Creek, CA 94596 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 16/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A41244 | (02) |