Provider Demographics
NPI:1023323870
Name:DEWAR MEDICAL GROUP INC
Entity type:Organization
Organization Name:DEWAR MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SENECA
Authorized Official - Middle Name:T
Authorized Official - Last Name:DEWAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-886-6576
Mailing Address - Street 1:399 E HIGHLAND AVE STE 124
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92404-3854
Mailing Address - Country:US
Mailing Address - Phone:909-886-6576
Mailing Address - Fax:909-882-1299
Practice Address - Street 1:399 E HIGHLAND AVE STE 124
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-3854
Practice Address - Country:US
Practice Address - Phone:909-886-6576
Practice Address - Fax:909-882-1299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA33700207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA27222Medicare UPIN