MEDICARE: DOUGLAS ALAN JEW

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1558705780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS ALAN JEW

Provider Business Mailing Address
First Line	:	9 N 9TH ST
Second Line	:	APT. #305
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-3121
Country	:	US
Telephone Number	:	512-767-4340
Fax Number	:

Provider Business Practice Location Address
First Line	:	9 N 9TH ST
Second Line	:	APT. #305
City	:	PHILADELPHIA
State	:	PA
Zip	:	19107-3121
Country	:	US
Telephone Number	:	512-767-4340
Fax Number	:

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

Provider Enumeration Date	:	04/18/2013
Last Update Date	:	05/26/2016

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