Provider Demographics
NPI:1669489241
Name:DEWAR, MARVIN A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:A
Last Name:DEWAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MARVIN
Other - Middle Name:ALEXANDER
Other - Last Name:DEWAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-265-8309
Mailing Address - Fax:352-265-8077
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-265-8309
Practice Address - Fax:352-265-8077
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2012-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME38942207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067537700Medicaid
FL64494YMedicare PIN
FL067537700Medicaid