Individual
DR. JAMES DANIEL DEWAR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
530 NE GLEN OAK AVE, PEORIA, IL 61637-0001
(309) 655-7257
Mailing address
103 WOODBROOK CT, EAST PEORIA, IL 61611-4779
(309) 922-1006
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
125-049248
IL
207RI0011X
Interventional Cardiology Physician
Primary
56304
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036120002
—
IL
01
—
809840
MEDICARE GROUP
IL
01
—
CA4079
RR MEDICARE GROUP PTAN
IL
01
—
P00617111
RR MEDICARE GROUP MEMBER PTAN
IL
Enumeration date
05/28/2007
Last updated
08/29/2013
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