Individual
JONATHON G DEWALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2605 FOREST HILLS RD SW, SUITE B, WILSON, NC 27893-4448
(252) 243-7542
Mailing address
PO BOX 3585, WILSON, NC 27895-3585
(252) 243-7542
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
28169
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
28378
BLUE CROSS/BLUE SHIELD
NC
05
—
8928378
—
NC
Enumeration date
01/26/2006
Last updated
03/04/2008
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