Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207ND0900X | Dermatopathologist | G358260 | CA |
NPI | 1104866060 |
---|---|
Provider Name | Eric Alden Lewis |
First Address | Beverly Hills, CA 90211 |
Second Address | Beverly Hills, CA 90211-2103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 24/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A46489 | (02) | CA |