Provider Demographics
NPI:1336285782
Name:SOUTHWESTERN OBSTETRICS & GYNECOLOGY P C
Entity Type:Organization
Organization Name:SOUTHWESTERN OBSTETRICS & GYNECOLOGY P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:DEWEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:801-465-9263
Mailing Address - Street 1:39 PROFESSIONAL WAY
Mailing Address - Street 2:#3
Mailing Address - City:PAYSON
Mailing Address - State:UT
Mailing Address - Zip Code:84651-1675
Mailing Address - Country:US
Mailing Address - Phone:801-465-9263
Mailing Address - Fax:801-465-1669
Practice Address - Street 1:39 PROFESSIONAL WAY
Practice Address - Street 2:#3
Practice Address - City:PAYSON
Practice Address - State:UT
Practice Address - Zip Code:84651-1675
Practice Address - Country:US
Practice Address - Phone:801-465-9263
Practice Address - Fax:801-465-1669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT177851-1205207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT528887176001Medicaid
UT000057891Medicare ID - Type Unspecified