MEDICARE: DR. BEAU VANCE DUWE 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	207R00000X	Internal Medicine Physician	MD427048	PA
2	207R00000X	Internal Medicine Physician	A98194	CA

General Provider Information

NPI Number	:	1912012824
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BEAU VANCE DUWE M.D.

Provider Business Mailing Address
First Line	:	1406 TYLER AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-2338
Country	:	US
Telephone Number	:	267-235-7771
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 W ARBOR DR # 8383
Second Line	:	UCSD MEDICAL CENTER
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-1911
Country	:	US
Telephone Number	:	619-543-5972
Fax Number	:

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

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	11/22/2021

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