Provider Demographics
NPI:1972554467
Name:HEWELL, GEORGE M (MD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:M
Last Name:HEWELL
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 1:1300 MEDICAL AVE
Mailing Address - Street 2:#102
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-7799
Mailing Address - Country:US
Mailing Address - Phone:972-612-8431
Mailing Address - Fax:972-612-0223
Practice Address - Street 1:1300 MEDICAL AVE
Practice Address - Street 2:#102
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-7799
Practice Address - Country:US
Practice Address - Phone:972-612-8431
Practice Address - Fax:972-612-0223
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD9493207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQL89Medicare ID - Type Unspecified
TXB23467Medicare UPIN