MEDICARE: ROSEMARY ELLEN DETWEILER M.D.

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
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	H5868	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	P00281152	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	8S1225	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1598783136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSEMARY ELLEN DETWEILER M.D.

Provider Business Mailing Address
First Line	:	1355 RIVER BEND DRIVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75247-4915
Country	:	US
Telephone Number	:	214-638-2000
Fax Number	:	214-237-1864

Provider Business Practice Location Address
First Line	:	6100 HARRIS PARKWAY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4126
Country	:	US
Telephone Number	:	214-638-2000
Fax Number	:	214-237-1864

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	03/23/2015

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