Provider Demographics
NPI:1982746988
Name:GASS, LEWIS (MD)
Entity type:Individual
Prefix:DR
First Name:LEWIS
Middle Name:
Last Name:GASS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 N CAMDEN DR
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-3026
Mailing Address - Country:US
Mailing Address - Phone:310-275-6991
Mailing Address - Fax:
Practice Address - Street 1:810 N CAMDEN DR
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-3026
Practice Address - Country:US
Practice Address - Phone:310-275-6991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2015-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAFE19285207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ444442Medicaid
CAA86008Medicare UPIN
CAZZZ444442Medicaid