MEDICARE: DANIEL DEWERD 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	207Y00000X	Otolaryngology Physician	CFE28735	CA

General Provider Information

NPI Number	:	1447663794
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL DEWERD MD

Provider Business Mailing Address
First Line	:	3627 RIVIERA DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-6641
Country	:	US
Telephone Number	:	858-270-0239
Fax Number	:	858-270-0239

Provider Business Practice Location Address
First Line	:	3627 RIVIERA DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-6641
Country	:	US
Telephone Number	:	858-270-0239
Fax Number	:	858-270-0239

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

Provider Enumeration Date	:	06/04/2014
Last Update Date	:	06/04/2014

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