| Douglas M Tew Md Llc | |
|
2 Pavilion Place Penney Farms FL 32079 | |
| (904) 945-1224 | |
| Not Available |
| Full Name | Douglas M Tew Md Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 2 Pavilion Place, Penney Farms, Florida |
| Authorized Official Name and Position | Douglas M Tew (OWNER) |
| Authorized Official Contact | 9049451224 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Douglas M Tew Md Llc 2301 Park Ave Ste 209 Orange Park FL 32073-5558 Ph: (904) 945-1224 | Douglas M Tew Md Llc 2 Pavilion Place Penney Farms FL 32079 Ph: (904) 945-1224 |
| NPI Number | 1114482494 |
|---|---|
| Provider Enumeration Date | 01/31/2019 |
| Last Update Date | 01/31/2019 |
| Medicare PECOS PAC ID | 2567795909 |
|---|---|
| Medicare Enrollment ID | O20190617003191 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114482494 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Douglas M Tew |
|---|---|
| Provider Type | Practitioner - Cardiovascular Disease (cardiology) |
| Provider Identifiers | NPI Number: 1568429769 PECOS PAC ID: 0941368377 Enrollment ID: I20081029000108 |
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