Provider Demographics
NPI:1558705780
Name:JEW, DOUGLAS ALAN
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:ALAN
Last Name:JEW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 N 9TH ST
Mailing Address - Street 2:APT. #305
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-3121
Mailing Address - Country:US
Mailing Address - Phone:512-767-4340
Mailing Address - Fax:
Practice Address - Street 1:9 N 9TH ST
Practice Address - Street 2:APT. #305
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-3121
Practice Address - Country:US
Practice Address - Phone:512-767-4340
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-18
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program