Organization
DEWITT FAMILY CARE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RONALD GLENN DEWITT M.D. (OWNER)
(512) 263-9111
Entity
Organization
Contact information
Practice address
1700 RR 620 S, SUITE B, LAKEWAY, TX 78734-6245
(512) 263-9111
(512) 263-3122
Mailing address
1700 RR 620 S, SUITE B, LAKEWAY, TX 78734-6245
(512) 263-9111
(512) 263-3122
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00QM64
BLUE CROSS BLUE SHIELD
TX
Enumeration date
08/17/2007
Last updated
08/17/2007
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