Healthcare Provider Details

I. General information

NPI: 1861477325
Provider Name (Legal Business Name): DEWEY A CHRISTMAS JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 W GRANADA BLVD SUITE 4
ORMOND BEACH FL
32174-8154
US

IV. Provider business mailing address

1050 W GRANADA BLVD SUITE 4
ORMOND BEACH FL
32174-8154
US

V. Phone/Fax

Practice location:
  • Phone: 386-677-8808
  • Fax: 386-677-9919
Mailing address:
  • Phone: 386-677-8808
  • Fax: 386-677-9919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME14979
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: