Provider Demographics
NPI:1417913641
Name:DEWAR, JAMES BAKER (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:BAKER
Last Name:DEWAR
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 1:601 CLEMSON RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29229-4341
Mailing Address - Country:US
Mailing Address - Phone:803-788-6146
Mailing Address - Fax:803-462-0312
Practice Address - Street 1:1970 AUGUSTA HWY
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:SC
Practice Address - Zip Code:29072-2206
Practice Address - Country:US
Practice Address - Phone:803-358-2370
Practice Address - Fax:803-462-0312
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19726174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC197263Medicaid
SCH14589Medicare UPIN