Provider Demographics
NPI:1386654028
Name:SANDBERG, DEWEY (MD)
Entity Type:Individual
Prefix:DR
First Name:DEWEY
Middle Name:
Last Name:SANDBERG
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 1:931 OAK PARK BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-3402
Mailing Address - Country:US
Mailing Address - Phone:805-474-2600
Mailing Address - Fax:805-474-2607
Practice Address - Street 1:931 OAK PARK BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-3402
Practice Address - Country:US
Practice Address - Phone:805-474-2600
Practice Address - Fax:805-474-2607
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55929207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA53057Medicare UPIN