# B. DOUGLAS LEWIS, M.D., A PROFESSIONAL CORPORATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Peninsula Vascular Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1013168491
- **Authorized official:** BRIAN DOUGLAS LEWIS M.D. (PRESIDENT)
- **Authorized official phone:** (650) 364-3600

## Contact information

- **Practice address:** 3351 EL CAMINO REAL STE 205, ATHERTON, CA 94027-3864
- **Practice address phone:** (650) 364-3600
- **Practice address fax:** (650) 364-3609
- **Mailing address:** 3351 EL CAMINO REAL STE 205, ATHERTON, CA 94027-3864
- **Mailing address phone:** (650) 364-3600
- **Mailing address fax:** (650) 364-3609

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | G48356 | CA | Yes |
| 261QR0200X | Radiology Clinic/Center | G48356 | CA | — |

## Other

- **Enumeration date:** 10/03/2008
- **Last updated:** 10/03/2008