Provider Demographics
NPI:1598038945
Name:PAUL, DEWITT J III (C PED)
Entity Type:Individual
Prefix:MR
First Name:DEWITT
Middle Name:J
Last Name:PAUL
Suffix:III
Gender:M
Credentials:C PED
Other - Prefix:
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Mailing Address - Street 1:10520 S EASTERN AVE # 100
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-3900
Mailing Address - Country:US
Mailing Address - Phone:702-838-8111
Mailing Address - Fax:702-838-8115
Practice Address - Street 1:10520 S EASTERN AVE # 100
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-3900
Practice Address - Country:US
Practice Address - Phone:702-838-8111
Practice Address - Fax:702-838-8115
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-15
Last Update Date:2012-02-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NVMP00225332B00000X, 335E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No335E00000XSuppliersProsthetic/Orthotic Supplier