Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | G48589 | CA |
N | 2080P0208X | Pediatric Infectious Diseases | G48589 | CA |
NPI | 1255466983 |
---|---|
Provider Name | Dr. David Bram Lewis |
First Address | Palo Alto, CA 94304-1503 |
Second Address | Palo Alto, CA 94304-1503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2007 |
Last Update Date | 16/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G485890 | (05) | CA |
E34864 | (02) | CA |