Provider Demographics
NPI:1881639763
Name:DEWEY, RICHARD C (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:C
Last Name:DEWEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1297 BURNS WAY
Mailing Address - Street 2:SUITE 4
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3166
Mailing Address - Country:US
Mailing Address - Phone:406-752-5170
Mailing Address - Fax:
Practice Address - Street 1:1297 BURNS WAY
Practice Address - Street 2:SUITE 4
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3166
Practice Address - Country:US
Practice Address - Phone:406-752-5170
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3893207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT57851Medicaid
MT91995OtherBLUE CROSS
D96104Medicare UPIN
MT83128Medicare ID - Type Unspecified