MEDICARE: THE DEWITT CLINIC PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	H1950	TX
2	207Q00000X	Family Medicine Physician	K6975	TX

General Provider Information

NPI Number	:	1043202997
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE DEWITT CLINIC PA

Provider Business Mailing Address
First Line	:	304 MEDIC LANE
Second Line	:	SUITE B
City	:	ALVIN
State	:	TX
Zip	:	77511-5543
Country	:	US
Telephone Number	:	281-331-2062
Fax Number	:	281-331-8070

Provider Business Practice Location Address
First Line	:	304 MEDIC LANE
Second Line	:	SUITE B
City	:	ALVIN
State	:	TX
Zip	:	77511-5543
Country	:	US
Telephone Number	:	281-331-2062
Fax Number	:	281-331-8070

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. ROBERT D DEWITT
Credential	:	MD
Telephone Number	:	281-331-2062

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	11/08/2007

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Directions to “THE DEWITT CLINIC PA ” Practice Location

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