Provider Demographics
NPI:1366928798
Name:DEWITT ASSOCIATES DOPA
Entity type:Organization
Organization Name:DEWITT ASSOCIATES DOPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JT
Authorized Official - Middle Name:
Authorized Official - Last Name:DEWITT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:870-236-2911
Mailing Address - Street 1:3501 CARRIAGE HILL DR STE B
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-5329
Mailing Address - Country:US
Mailing Address - Phone:870-236-2911
Mailing Address - Fax:870-236-2911
Practice Address - Street 1:3501 CARRIAGE HILL DR STE B
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-5329
Practice Address - Country:US
Practice Address - Phone:870-236-2911
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-18
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty