Provider Demographics
NPI:1407057649
Name:THWAITES, DWAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:DWAYNE
Middle Name:
Last Name:THWAITES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1134 N ROAD ST STE 5
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH CITY
Mailing Address - State:NC
Mailing Address - Zip Code:27909-3365
Mailing Address - Country:US
Mailing Address - Phone:305-323-6440
Mailing Address - Fax:252-335-0310
Practice Address - Street 1:1134 N ROAD ST STE 5
Practice Address - Street 2:
Practice Address - City:ELIZABETH CITY
Practice Address - State:NC
Practice Address - Zip Code:27909-3365
Practice Address - Country:US
Practice Address - Phone:305-243-3670
Practice Address - Fax:252-335-0310
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2008 01717208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology