Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 0103000648 | VA |
NPI | 1104997600 |
---|---|
Provider Name | Dr. David Elwood Detwiler |
First Address | Forest, VA 24551-1851 |
Second Address | Forest, VA 24551-1851 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2006 |
Last Update Date | 08/07/2007 |