Provider Demographics
NPI:1538140371
Name:DEWEY, DENNIS D (MD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:D
Last Name:DEWEY
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 746649
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-6649
Mailing Address - Country:US
Mailing Address - Phone:904-376-4400
Mailing Address - Fax:904-391-5595
Practice Address - Street 1:2310 VILLAGE SQUARE PKWY STE 202
Practice Address - Street 2:
Practice Address - City:FLEMING ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32003-6351
Practice Address - Country:US
Practice Address - Phone:904-516-1880
Practice Address - Fax:904-516-1885
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-09
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME479682084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL140001558OtherRAILROAD MEDICARE
FL14167OtherBCBS
FL14167WMedicare PIN
FL14167OtherBCBS
FL14167Medicare ID - Type Unspecified