Provider Demographics
NPI:1235592429
Name:DEWAR, ROBERT THOMAS
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:THOMAS
Last Name:DEWAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:226 W 14TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-7201
Mailing Address - Country:US
Mailing Address - Phone:817-913-0933
Mailing Address - Fax:
Practice Address - Street 1:2255 BRAESWOOD PARK DR
Practice Address - Street 2:APT 278
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-4454
Practice Address - Country:US
Practice Address - Phone:817-913-0933
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY293589207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program