Provider Demographics
NPI:1447454012
Name:LE, DEWEY (DO)
Entity type:Individual
Prefix:DR
First Name:DEWEY
Middle Name:
Last Name:LE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 9547
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-9547
Mailing Address - Country:US
Mailing Address - Phone:281-359-5981
Mailing Address - Fax:281-359-3591
Practice Address - Street 1:320 KINGWOOD EXECUTIVE DR STE E
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-2769
Practice Address - Country:US
Practice Address - Phone:281-359-5981
Practice Address - Fax:281-359-3591
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM48502084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX191031702Medicaid
TX8AQ460OtherBCBS
01221746OtherAMERIGROUP
7103954OtherAETNA
694374444OtherMYUTMB 694374444-COMMERCIAL NUMBER
TXP00656931Medicare PIN
694374444OtherMYUTMB 694374444-COMMERCIAL NUMBER
TX8K0510Medicare PIN