Healthcare Provider Details

I. General information

NPI: 1770876294
Provider Name (Legal Business Name): ROBERT E HEWLETT III D.V.M
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2011
Last Update Date: 05/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 BURT BLVD
BENTON LA
71006-4900
US

IV. Provider business mailing address

195 BURT BLVD
BENTON LA
71006-4900
US

V. Phone/Fax

Practice location:
  • Phone: 318-965-2371
  • Fax: 318-965-2384
Mailing address:
  • Phone: 318-965-2371
  • Fax: 318-965-2384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number1229
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code174M00000X
TaxonomyVeterinarian
License Number4530
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: