Provider Demographics
NPI:1659343853
Name:DEPOSITARIO-CABACAR, DEWI FRANCES TONELETE (MD)
Entity Type:Individual
Prefix:DR
First Name:DEWI FRANCES
Middle Name:TONELETE
Last Name:DEPOSITARIO-CABACAR
Suffix:
Gender:F
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 590
Mailing Address - Street 2:
Mailing Address - City:REDFIELD
Mailing Address - State:SD
Mailing Address - Zip Code:57469-0590
Mailing Address - Country:US
Mailing Address - Phone:605-472-0510
Mailing Address - Fax:605-472-0331
Practice Address - Street 1:1010 WEST 1ST STREET
Practice Address - Street 2:
Practice Address - City:REDFIELD
Practice Address - State:SD
Practice Address - Zip Code:57469-1506
Practice Address - Country:US
Practice Address - Phone:605-472-0510
Practice Address - Fax:605-472-0331
Is Sole Proprietor?:No
Enumeration Date:2006-02-02
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4766208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5611340Medicaid
SDH77038Medicare ID - Type Unspecified
SD5611340Medicaid