Individual
DR. JACK BITTELL SEWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
901 E SUNFLOWER RD, CLEVELAND, MS 38732-2833
(662) 846-0061
Mailing address
PO BOX 468, BERWICK, PA 18603-0468
(610) 956-0003
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
05320
MS
2085R0202X
Diagnostic Radiology Physician
ME22971
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
134262411
TAX ID
FL
01
—
58248
BCBS
FL
01
—
P00041336
MEDICARE RR
FL
Enumeration date
09/01/2005
Last updated
06/15/2011
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