MEDICARE: NICHOLAS ALEXANDER DEWYER 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	207YX0901X	Otology & Neurotology Physician	57999	AZ
2	207Y00000X	Otolaryngology Physician	273495	MA
3	207YX0901X	Otology & Neurotology Physician	A131058	CA

General Provider Information

NPI Number	:	1154671089
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLAS ALEXANDER DEWYER MD

Provider Business Mailing Address
First Line	:	PO BOX 276950
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95827-6950
Country	:	US
Telephone Number	:	415-600-0151
Fax Number	:

Provider Business Practice Location Address
First Line	:	2340 CLAY ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-1932
Country	:	US
Telephone Number	:	415-600-0151
Fax Number	:

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

Provider Enumeration Date	:	09/18/2012
Last Update Date	:	01/13/2026

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