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NPI Code Detail

MEDICARE: DR. FLOY EVON DETWILER MD

MEDICARE:  DR. FLOY EVON DETWILER  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianMD00037715WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306840020
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. FLOY EVON DETWILER MD
Provider Business Mailing Address
First Line : 820 N CHELAN AVE
Second Line :
City : WENATCHEE
State : WA
Zip : 98801-2028
Country : US
Telephone Number : 509-663-8711
Fax Number :
Provider Business Practice Location Address
First Line : 100 HIGHLINE DR
Second Line :
City : EAST WENATCHEE
State : WA
Zip : 98802-5341
Country : US
Telephone Number : 509-884-0614
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2005
Last Update Date : 05/28/2013

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Directions to “ DR. FLOY EVON DETWILER MD” Practice Location

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