MEDICARE: DR. JAMES WALTER EWING PH.D.

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	174400000X	Specialist	NONE

General Provider Information

NPI Number	:	1679783385
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES WALTER EWING PH.D.

Provider Business Mailing Address
First Line	:	3957 30TH ST #517
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-3004
Country	:	US
Telephone Number	:	619-295-5431
Fax Number	:	619-291-3441

Provider Business Practice Location Address
First Line	:	3957 30TH ST # 517
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92104-3004
Country	:	US
Telephone Number	:	619-847-1018
Fax Number	:	619-291-3441

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/08/2007

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