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NPI Code Detail

MEDICARE: DR. JACQUELIN DAWN DEWBRE DO

MEDICARE: DR. JACQUELIN DAWN DEWBRE DO
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
1208000000XPediatrics PhysicianM0391TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18H3678OTHERTXBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1346211893
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACQUELIN DAWN DEWBRE DO
Provider Business Mailing Address
First Line : PO BOX 848476
Second Line :
City : DALLAS
State : TX
Zip : 75284-8476
Country : US
Telephone Number : 254-202-4655
Fax Number : 254-202-4697
Provider Business Practice Location Address
First Line : 120 HILLCREST MEDICAL BLVD STE 100
Second Line :
City : WACO
State : TX
Zip : 76712-8949
Country : US
Telephone Number : 254-202-6100
Fax Number : 254-202-6195
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2006
Last Update Date : 09/03/2020

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