MEDICARE: DR. DEWEY LE DO

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	2084N0400X	Neurology Physician	M4850	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	8AQ460	OTHER	TX	BCBS
3	01221746	OTHER		AMERIGROUP
4	7103954	OTHER		AETNA

General Provider Information

NPI Number	:	1447454012
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEWEY LE DO

Provider Business Mailing Address
First Line	:	PO BOX 9547
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-9547
Country	:	US
Telephone Number	:	281-359-5981
Fax Number	:	281-359-3591

Provider Business Practice Location Address
First Line	:	320 KINGWOOD EXECUTIVE DR STE E
Second Line	:
City	:	KINGWOOD
State	:	TX
Zip	:	77339-2769
Country	:	US
Telephone Number	:	281-359-5981
Fax Number	:	281-359-3591

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

Provider Enumeration Date	:	06/14/2007
Last Update Date	:	11/20/2024

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Directions to “ DR. DEWEY LE DO” Practice Location

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