Provider Demographics
NPI:1316048234
Name:LEWIS, SAMUEL JAY (MD)
Entity type:Individual
Prefix:
First Name:SAMUEL
Middle Name:JAY
Last Name:LEWIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:15 ALTARINDA RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORINDA
Mailing Address - State:CA
Mailing Address - Zip Code:94563-2607
Mailing Address - Country:US
Mailing Address - Phone:925-253-1199
Mailing Address - Fax:925-253-1110
Practice Address - Street 1:15 ALTARINDA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ORINDA
Practice Address - State:CA
Practice Address - Zip Code:94563-2607
Practice Address - Country:US
Practice Address - Phone:925-253-1199
Practice Address - Fax:925-253-1110
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2008-09-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA23905208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4115737OtherAETNA
CA90010677OtherPACIFICARE
CA942438137OtherBLUE CROSS, HEALTH NET