Provider Demographics
NPI:1780919795
Name:DEWEESE, JOSEPH (NP)
Entity type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:
Last Name:DEWEESE
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19222 STONEHUE
Mailing Address - Street 2:STE 101
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-3453
Mailing Address - Country:US
Mailing Address - Phone:210-403-3220
Mailing Address - Fax:
Practice Address - Street 1:19222 STONEHUE
Practice Address - Street 2:STE 101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-3453
Practice Address - Country:US
Practice Address - Phone:210-403-3220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX665075363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily