MEDICARE: DR. PETER A EWEJE 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	207RG0100X	Gastroenterology Physician	00941	NC

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	10612	OTHER	NC	BCBS

General Provider Information

NPI Number	:	1871538363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER A EWEJE MD

Provider Business Mailing Address
First Line	:	PO BOX 12114
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-2114
Country	:	US
Telephone Number	:	910-353-6158
Fax Number	:	910-353-7257

Provider Business Practice Location Address
First Line	:	4 OFFICE PARK DR
Second Line	:
City	:	JACKSONVILLE
State	:	NC
Zip	:	28546-7325
Country	:	US
Telephone Number	:	910-353-6158
Fax Number	:	910-353-7257

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

Provider Enumeration Date	:	06/18/2006
Last Update Date	:	04/11/2011

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