Healthcare Provider Details

I. General information

NPI: 1477583565
Provider Name (Legal Business Name): GEORGE R HEWES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 08/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 FOREST AVE SUITE B
SAN JOSE CA
95128-1469
US

IV. Provider business mailing address

PO BOX 620930
WOODSIDE CA
94062-0930
US

V. Phone/Fax

Practice location:
  • Phone: 408-295-3433
  • Fax: 408-293-4872
Mailing address:
  • Phone: 408-295-3433
  • Fax: 408-293-4872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG13639
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: