Individual
DEXTER D DEWITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
126 E MAIN ST, SUITE B, PAYSON, AZ 85541-5488
(928) 468-5437
Mailing address
7100 COMMERCE WAY, SUITE 180, BRENTWOOD, TN 37027-2829
(615) 465-7000
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
6525
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0017101703
—
AZ
01
—
AZ0851710
BCBS
AZ
Enumeration date
07/14/2005
Last updated
12/06/2007
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