MEDICARE: MICHAEL E JEWETT M.D.

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	207Q00000X	Family Medicine Physician	MD37121	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	TN01Q8	OTHER	TN	JOHN DEERE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4054466	OTHER	TN	BCBS

General Provider Information

NPI Number	:	1780648063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL E JEWETT M.D.

Provider Business Mailing Address
First Line	:	PO BOX 556
Second Line	:
City	:	JONESBOROUGH
State	:	TN
Zip	:	37659-0556
Country	:	US
Telephone Number	:	423-788-0123
Fax Number	:	866-212-2654

Provider Business Practice Location Address
First Line	:	121 E MAIN ST
Second Line	:
City	:	JONESBOROUGH
State	:	TN
Zip	:	37659-1317
Country	:	US
Telephone Number	:	423-788-0123
Fax Number	:	866-212-2654

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

Provider Enumeration Date	:	04/14/2006
Last Update Date	:	01/14/2011

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