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General NPI Number Information
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NPI Number | 1801075619
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Entity Type | Organization
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Legal Business Name | OWEN C. DEWITT, MD
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Dates
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Enumeration Date | 10/29/2007
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Last Update Date | 02/22/2008
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Provider Practice Location Address
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Address Line | 1307 8TH AVE STE 603
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City | FORT WORTH
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State | TX
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Zip | 76104-4142
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Country | US
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Telephone | 817-336-1071
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Fax | 817-546-8681
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Provider Business Mailing Address
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Address Line | PO BOX 11128
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City | FORT WORTH
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State | TX
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Zip | 76110-0128
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Country | US
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Telephone | 817-336-1071
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Fax | 817-546-8681
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | OWEN C. DEWITT
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Credential | MD
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Telephone | 817-336-1071
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G3287
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License Number State | TX
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