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General NPI Number Information
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NPI Number | 1134624018
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Entity Type | Individual
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Provider Name | KYLE DEERWESTER MD
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Gender | Male
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Dates
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Enumeration Date | 03/24/2018
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Last Update Date | 03/21/2025
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Provider Practice Location Address
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Address Line | 680 CENTRE ST
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City | BROCKTON
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State | MA
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Zip | 02302-3308
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Country | US
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Telephone | 508-941-7580
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Fax | 508-941-6268
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Provider Business Mailing Address
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Address Line | 680 CENTRE ST
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City | BROCKTON
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State | MA
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Zip | 02302-3308
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Country | US
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Telephone | 508-941-7580
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Fax | 508-941-6268
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number | 036.159618
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2080P0203X
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Taxonomy Name | Pediatric Critical Care Medicine Physician
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License Number | 1019638
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License Number State | MA
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