Provider Demographics
NPI:1619554110
Name:DEWEY, JESSE (DO)
Entity type:Individual
Prefix:DR
First Name:JESSE
Middle Name:
Last Name:DEWEY
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:861 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHFIELD
Mailing Address - State:UT
Mailing Address - Zip Code:84701-1840
Mailing Address - Country:US
Mailing Address - Phone:360-739-4467
Mailing Address - Fax:435-558-7031
Practice Address - Street 1:861 N MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHFIELD
Practice Address - State:UT
Practice Address - Zip Code:84701-1840
Practice Address - Country:US
Practice Address - Phone:435-558-7031
Practice Address - Fax:435-558-7031
Is Sole Proprietor?:No
Enumeration Date:2021-03-29
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT14207082-1204207ND0101X, 207NS0135X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology