MEDICARE: MARY F. HEWITT, M.D., P.A.

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	207Q00000X	Family Medicine Physician	K5553	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	0047EN	OTHER	TX	BLUE CROSS & BLUE SHIELD
3	8F9488	OTHER	TX	INDIVIDUAL NPI/DR.MARY FAYE HEWITT M.D.

General Provider Information

NPI Number	:	1194970152
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARY F. HEWITT, M.D., P.A.

Provider Business Mailing Address
First Line	:	PO BOX 2115
Second Line	:
City	:	BAYTOWN
State	:	TX
Zip	:	77522-2115
Country	:	US
Telephone Number	:	281-427-6363
Fax Number	:	281-420-6867

Provider Business Practice Location Address
First Line	:	2610 N ALEXANDER DR
Second Line	:	SUITE 201
City	:	BAYTOWN
State	:	TX
Zip	:	77520-3368
Country	:	US
Telephone Number	:	281-427-6363
Fax Number	:	281-420-6867

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARY FAYE HEWITT
Credential	:	M.D.
Telephone Number	:	281-427-6363

Provider Enumeration Date	:	11/18/2008
Last Update Date	:	02/04/2009

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