Provider Demographics
NPI:1477583565
Name:HEWES, GEORGE R (MD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:R
Last Name:HEWES
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:PO BOX 620930
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:94062-0930
Mailing Address - Country:US
Mailing Address - Phone:408-295-3433
Mailing Address - Fax:408-293-4872
Practice Address - Street 1:2110 FOREST AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1469
Practice Address - Country:US
Practice Address - Phone:408-295-3433
Practice Address - Fax:408-293-4872
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG13639207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A39048Medicare UPIN