MEDICARE: DR. JULIA ANNETTE PEWITT D.O.

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	2003014169	MO
2	207Q00000X	Family Medicine Physician	L7844	TX

General Provider Information

NPI Number	:	1346487931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIA ANNETTE PEWITT D.O.

Provider Business Mailing Address
First Line	:	2387 W JACKSON BLVD
Second Line	:
City	:	JACKSON
State	:	MO
Zip	:	63755-3024
Country	:	US
Telephone Number	:	573-243-9288
Fax Number	:	573-204-7074

Provider Business Practice Location Address
First Line	:	2387 W JACKSON BLVD
Second Line	:
City	:	JACKSON
State	:	MO
Zip	:	63755-3024
Country	:	US
Telephone Number	:	573-243-9288
Fax Number	:	573-204-7074

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

Provider Enumeration Date	:	01/19/2009
Last Update Date	:	09/15/2011

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