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NPI Code Detail

MEDICARE: DR. RONALD GLENN DEWITT M.D.

MEDICARE: DR. RONALD GLENN DEWITT M.D.
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
1207Q00000XFamily Medicine PhysicianG7054TX

General Provider Information

NPI Number : 1275546269
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. RONALD GLENN DEWITT M.D.
Provider Business Mailing Address
First Line : PO BOX 844658
Second Line :
City : DALLAS
State : TX
Zip : 75284-4658
Country : US
Telephone Number : 254-724-8800
Fax Number :
Provider Business Practice Location Address
First Line : 3108 RANCH ROAD 620 S
Second Line :
City : LAKEWAY
State : TX
Zip : 78738-5635
Country : US
Telephone Number : 512-654-4200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/14/2006
Last Update Date : 11/08/2023

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