Provider Demographics
NPI:1346211893
Name:DEWBRE, JACQUELIN DAWN (DO)
Entity Type:Individual
Prefix:DR
First Name:JACQUELIN
Middle Name:DAWN
Last Name:DEWBRE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JACQUELIN
Other - Middle Name:DAWN
Other - Last Name:RABE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 848476
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-8476
Mailing Address - Country:US
Mailing Address - Phone:254-202-4655
Mailing Address - Fax:254-202-4697
Practice Address - Street 1:120 HILLCREST MEDICAL BLVD STE 100
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-8949
Practice Address - Country:US
Practice Address - Phone:254-202-6100
Practice Address - Fax:254-202-6195
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0391208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8H3678OtherBCBS
TX175870801Medicaid
8D8873Medicare PIN
TX175870801Medicaid
TX8D8873Medicare ID - Type Unspecified