1811901119 NPI number — ROBERT P. BEWLEY, DPM, PA

Table of content: (NPI 1811901119)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811901119 NPI number — ROBERT P. BEWLEY, DPM, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT P. BEWLEY, DPM, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1811901119
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
601 E DIXIE AVE
Provider Second Line Business Mailing Address:
PLAZA 804
Provider Business Mailing Address City Name:
LEESBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34748-5953
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
352-728-1252
Provider Business Mailing Address Fax Number:
352-728-0079

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 E DIXIE AVE
Provider Second Line Business Practice Location Address:
PLAZA 804
Provider Business Practice Location Address City Name:
LEESBURG
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34748-5953
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
352-728-1252
Provider Business Practice Location Address Fax Number:
352-728-0079
Provider Enumeration Date:
07/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BEWLEY
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
P
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
352-728-1252

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  PO693 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 45125 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: CF7533 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: K1457 . This is a "MEDICARE PTAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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