Provider Demographics
NPI:1346487931
Name:PEWITT, JULIA ANNETTE (DO)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:ANNETTE
Last Name:PEWITT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:2387 W JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-3024
Mailing Address - Country:US
Mailing Address - Phone:573-243-9288
Mailing Address - Fax:573-204-7074
Practice Address - Street 1:2387 W JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-3024
Practice Address - Country:US
Practice Address - Phone:573-243-9288
Practice Address - Fax:573-204-7074
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-19
Last Update Date:2011-09-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2003014169207Q00000X
TXL7844207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine