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General NPI Number Information
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NPI Number | 1174642771
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Entity Type | Organization
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Legal Business Name | DAVID E DETWILER PC
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 08/16/2007
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Provider Practice Location Address
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Address Line | 101 PERSIMMON WAY
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City | FOREST
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State | VA
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Zip | 24551-1851
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Country | US
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Telephone | 434-525-3045
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Fax |
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Provider Business Mailing Address
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Address Line | 101 PERSIMMON WAY
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City | FOREST
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State | VA
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Zip | 24551-1851
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Country | US
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Telephone | 434-525-3045
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DAVID DETWILER
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Credential |
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Telephone | 434-525-3045
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 0103000648
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License Number State | VA
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