Provider Demographics
NPI:1558335695
Name:DWEK, JERRY R (MD)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:R
Last Name:DWEK
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 1:725 WELCH RD
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94304-1601
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:725 WELCH RD
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1601
Practice Address - Country:US
Practice Address - Phone:650-497-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-15
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG860732085P0229X, 2085R0202X, 2085B0100X, 2085U0001X, 2085N0700X, 2085N0904X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085P0229XAllopathic & Osteopathic PhysiciansRadiologyPediatric Radiology
No2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Ultrasound
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0083814Medicaid
CAGR0083812Medicaid
CAGR0083815Medicaid
CAGR0083817Medicaid
CAZZZ75341ZMedicaid
CAGR0083813Medicaid
CAGR0083815Medicaid
CAZZZ75341ZMedicaid
CAGR0083813Medicaid
CAW529Medicare PIN
CATD009AMedicare PIN
CAGR0083810Medicaid
CAGR0083817Medicaid
CAHW529BMedicare PIN
CAHW529AMedicare PIN
CAGR0083816Medicaid
CAGR0083815Medicaid
CAZZZ75341ZMedicaid
CATD009Medicare PIN