Paul Theodore Dewitt Jr., MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

PD039384 Issued in MI

Practice address

1005 W Green St
Suite 100
Hastings, MI 49058-1712

Phone

(269) 948-2173

Fax

(269) 948-4489

NPI assigned

Jun 5, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395273600000",
    "number": "1952340192",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1005 W GREEN ST",
            "address_2": "SUITE 100",
            "city": "HASTINGS",
            "state": "MI",
            "postal_code": "490581712",
            "telephone_number": "269-948-2173",
            "fax_number": "269-948-4489"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1005 W GREEN ST",
            "address_2": "SUITE 100",
            "city": "HASTINGS",
            "state": "MI",
            "postal_code": "490581712",
            "telephone_number": "269-948-2173",
            "fax_number": "269-948-4489"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEWITT",
        "first_name": "PAUL",
        "middle_name": "THEODORE",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-05",
        "last_updated": "2014-03-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "PD039384",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2093009",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cody Davis, B.S.; QIDP
• Sarah Declarke
• Oscar Degoa, MD
• Diane Denny
• Donald Desano
• Barbara Andrea Diaz Hernandez, MD
• Diana Catherine Diemer, FNP
• Skylar Dixon, LLMSW
• Kelsey Warren Dodge, LMSW
• Jeffrey Jon Dood, M.D.

• Family Medicine Physician in Hastings, MI
• Providers in Hastings, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2014; 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.