MEDICARE: DUSTIN FERREL TEW 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	2085R0202X	Diagnostic Radiology Physician	20A18766	CA
2	2085R0204X	Vascular & Interventional Radiology Physician	O-1634	ID

General Provider Information

NPI Number	:	1568821163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DUSTIN FERREL TEW D.O.

Provider Business Mailing Address
First Line	:	11929 BRIARLEAF WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-5254
Country	:	US
Telephone Number	:	208-339-4239
Fax Number	:

Provider Business Practice Location Address
First Line	:	2265 E SUNNYSIDE RD
Second Line	:
City	:	IDAHO FALLS
State	:	ID
Zip	:	83404-7598
Country	:	US
Telephone Number	:	208-542-5000
Fax Number	:

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

Provider Enumeration Date	:	02/11/2016
Last Update Date	:	06/26/2026

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