MEDICARE: DEREK KERN HEWITT MD

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	207Y00000X	Otolaryngology Physician	T2003013836	MO

General Provider Information

NPI Number	:	1083718266
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEREK KERN HEWITT MD

Provider Business Mailing Address
First Line	:	PO BOX 7687
Second Line	:
City	:	COLUMBIA
State	:	MO
Zip	:	65202
Country	:	US
Telephone Number	:	573-882-2259
Fax Number	:	573-884-8526

Provider Business Practice Location Address
First Line	:	1125 W IRON SPRINGS RD
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86305-1623
Country	:	US
Telephone Number	:	928-778-9190
Fax Number	:	928-778-3005

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2006
Last Update Date	:	08/14/2012

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