Healthcare Provider Details

I. General information

NPI: 1003979931
Provider Name (Legal Business Name): ANDREW HEWCHUCK D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2006
Last Update Date: 05/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 W LINE ST
BISHOP CA
93514-3413
US

IV. Provider business mailing address

310 W LINE ST
BISHOP CA
93514-3413
US

V. Phone/Fax

Practice location:
  • Phone: 760-872-1636
  • Fax:
Mailing address:
  • Phone: 760-872-1636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE3878
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number9503
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: