Healthcare Provider Details

I. General information

NPI: 1760593099
Provider Name (Legal Business Name): PATRICK JEWELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1285 WAIANUENUE AVE FL 1
HILO HI
96720-1209
US

IV. Provider business mailing address

844 N 5TH AVE
SEQUIM WA
98382-3045
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone: 360-683-9895
  • Fax: 360-582-2820

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberML20008239
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberDR.0054195
License Number StateCO
# 3
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberMD-13598
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: