1770514929 NPI number — DAVID G DEWAR M.D.

Table of content: DAVID G DEWAR M.D. (NPI 1770514929)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770514929 NPI number — DAVID G DEWAR M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEWAR
Provider First Name:
DAVID
Provider Middle Name:
G
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1770514929
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10330 N MERIDIAN ST
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46290-1024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 SKYVIEW DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHESTERFIELD
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46017-1057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
765-378-1572
Provider Business Practice Location Address Fax Number:
765-378-1580
Provider Enumeration Date:
07/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  01043269 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: DC3600 . This is a "RAILROAD GROUP" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 200030980 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: CK6957 . This is a "RAILROAD GROUP" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: P00426385 . This is a "RAILROAD INDIVIDUAL" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 15D0889968 . This is a "CLIA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: P00714993 . This is a "RAILROAD INDIVIDUAL" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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