MEDICARE: JULIA R. DE WETTE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	F6573	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427063585
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIA R. DE WETTE MD

Provider Business Mailing Address
First Line	:	PO BOX 26726
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78755-0726
Country	:	US
Telephone Number	:	512-407-8686
Fax Number	:	512-406-6216

Provider Business Practice Location Address
First Line	:	1807 W SLAUGHTER LN
Second Line	:	#490
City	:	AUSTIN
State	:	TX
Zip	:	78748-6208
Country	:	US
Telephone Number	:	512-282-8967
Fax Number	:	512-292-5141

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/29/2006
Last Update Date	:	10/25/2011

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Directions to “ JULIA R. DE WETTE MD” Practice Location

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