Healthcare Provider Details

I. General information

NPI: 1649250499
Provider Name (Legal Business Name): HEWITT WILLIAM REESE DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 01/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13660 N 94TH DR F1
PEORIA AZ
85381-4836
US

IV. Provider business mailing address

13660 N 94TH DR F1
PEORIA AZ
85381-4836
US

V. Phone/Fax

Practice location:
  • Phone: 623-933-1373
  • Fax: 623-933-5787
Mailing address:
  • Phone: 623-933-1373
  • Fax: 623-933-5787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number0099
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: