Healthcare Provider Details

I. General information

NPI: 1174521942
Provider Name (Legal Business Name): DOUGLAS K DEW M.D. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 04/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6050 SAINT JOHNS AVE SUITE 3
PALATKA FL
32177-6860
US

IV. Provider business mailing address

PO BOX 1459
PALATKA FL
32178-1459
US

V. Phone/Fax

Practice location:
  • Phone: 904-825-2737
  • Fax: 904-825-2303
Mailing address:
  • Phone: 904-825-2737
  • Fax: 904-825-2303

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME51037
License Number StateFL

VIII. Authorized Official

Name: DR. DOUGLAS K DEW
Title or Position: ORTHOPAEDIC SURGEON
Credential: M.D., M.B.A.
Phone: 904-825-2737