Healthcare Provider Details

I. General information

NPI: 1649257460
Provider Name (Legal Business Name): HOWARD FREDERICK DETWILER JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2005
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4141 B ST STE 302
ANCHORAGE AK
99503-5942
US

IV. Provider business mailing address

4141 B ST STE 302
ANCHORAGE AK
99503-5942
US

V. Phone/Fax

Practice location:
  • Phone: 907-770-0585
  • Fax: 907-770-0586
Mailing address:
  • Phone: 907-770-0585
  • Fax: 907-770-0586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA36936
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD11166
License Number StateHI
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberAA2849
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: