Provider Demographics
NPI:1760521199
Name:DEWITT, JT JR (DO)
Entity Type:Individual
Prefix:DR
First Name:JT
Middle Name:
Last Name:DEWITT
Suffix:JR
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1206 GORDON DUCKWORTH DR
Mailing Address - Street 2:
Mailing Address - City:PIGGOTT
Mailing Address - State:AR
Mailing Address - Zip Code:72454-1911
Mailing Address - Country:US
Mailing Address - Phone:870-236-2911
Mailing Address - Fax:870-236-2912
Practice Address - Street 1:1206 GORDON DUCKWORTH DR
Practice Address - Street 2:
Practice Address - City:PIGGOTT
Practice Address - State:AR
Practice Address - Zip Code:72454-1911
Practice Address - Country:US
Practice Address - Phone:870-598-3881
Practice Address - Fax:870-598-5716
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2021-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS 13806207Q00000X
ARE-4975207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine