Provider Demographics
NPI:1124227962
Name:DEWET, PIETER JUAN (MD)
Entity Type:Individual
Prefix:DR
First Name:PIETER
Middle Name:JUAN
Last Name:DEWET
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:212 GRANDE BLVD
Mailing Address - Street 2:SUITE C114
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-4226
Mailing Address - Country:US
Mailing Address - Phone:903-939-2069
Mailing Address - Fax:903-939-2088
Practice Address - Street 1:212 GRANDE BLVD
Practice Address - Street 2:SUITE C114
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-4226
Practice Address - Country:US
Practice Address - Phone:903-939-2069
Practice Address - Fax:903-939-2088
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXJ0470207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine