Provider Demographics
NPI:1144316837
Name:DEWITT, JOSEPH CORNELL (MD)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:CORNELL
Last Name:DEWITT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 E TIMBERLANE DR
Mailing Address - Street 2:
Mailing Address - City:ALVIN
Mailing Address - State:TX
Mailing Address - Zip Code:77511-5245
Mailing Address - Country:US
Mailing Address - Phone:281-331-5153
Mailing Address - Fax:
Practice Address - Street 1:109 E TIMBERLANE DR
Practice Address - Street 2:
Practice Address - City:ALVIN
Practice Address - State:TX
Practice Address - Zip Code:77511-5245
Practice Address - Country:US
Practice Address - Phone:281-331-5153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD0112207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB22243Medicare UPIN