Provider Demographics
NPI:1154671089
Name:DEWYER, NICHOLAS ALEXANDER (MD)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:ALEXANDER
Last Name:DEWYER
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:PO BOX 245074
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85724-5074
Mailing Address - Country:US
Mailing Address - Phone:520-626-6673
Mailing Address - Fax:520-626-6995
Practice Address - Street 1:3838 N CAMPBELL AVE
Practice Address - Street 2:BLDG 2, CLINIC F (ENT)
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85719
Practice Address - Country:US
Practice Address - Phone:520-694-6144
Practice Address - Fax:520-694-6101
Is Sole Proprietor?:No
Enumeration Date:2012-09-18
Last Update Date:2023-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA273495207Y00000X
AZ57999207YX0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology