Individual
DEWAYNE EDWARD NIEBUR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
7600 OLD DOMINION CT, APTOS, CA 95003-3821
(831) 458-6200
Mailing address
325 DISTEL CIR, LOS ALTOS, CA 94022-1408
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
37733
CO
207Q00000X
Family Medicine Physician
Primary
C198328
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
04370236
—
CO
Enumeration date
03/15/2007
Last updated
08/27/2024
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