Individual provider Active NPI

Pieter Juan Dewet, M.D.

  • Family Medicine Physician
  • Tyler, TX
National Provider Identifier
1124227962
Registry record updated Jul 12, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
J0470 Issued in TX
Practice address
212 Grande Blvd
Suite C114
Tyler, TX 75703-4226
Phone
(903) 939-2069
Fax
(903) 939-2088
NPI assigned
Jul 12, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 12, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X J0470 TX Primary

Addresses

Primary practice location

212 Grande Blvd
Suite C114
Tyler, TX 75703-4226

Mailing address

212 Grande Blvd
Suite C114
Tyler, TX 75703-4226
Phone (903) 939-2069

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
J0470TXMDPediatric Cardiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
East Texas Medical Center Quitman Past Accepting new patients
East Texas Medical Center Past Accepting new patients
East Texas Medical Center Trinity Past Accepting new patients
East Texas Medical Center Quitman PastSince Feb 10, 2010 Accepting new patients

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184198400000",
    "number": "1124227962",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "212 GRANDE BLVD",
            "address_2": "SUITE C114",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757034226",
            "telephone_number": "903-939-2069",
            "fax_number": "903-939-2088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 GRANDE BLVD",
            "address_2": "SUITE C114",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757034226",
            "telephone_number": "903-939-2069",
            "fax_number": "903-939-2088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEWET",
        "first_name": "PIETER",
        "middle_name": "JUAN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-07-12",
        "last_updated": "2007-07-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "J0470",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tyler, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.