Healthcare Provider Details

I. General information

NPI: 1497311435
Provider Name (Legal Business Name): WILLIAM HENRY DETAR DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2019
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 RUSH DR
SALIDA CO
81201-9627
US

IV. Provider business mailing address

3551 ROGER BROOKE DR
SAN ANTONIO TX
78234-4504
US

V. Phone/Fax

Practice location:
  • Phone: 719-530-2200
  • Fax: 719-539-5068
Mailing address:
  • Phone: 210-292-5077
  • Fax: 210-292-7868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberO-1494
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberO-1494
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: