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Carl Ray Dettwiler, MD
Specialist in Lewiston, Idaho
NPI 1285623819

Carl Ray Dettwiler is a Specialist based in Lewiston, ID. Carl Ray Dettwiler practices in Lewiston, ID and has the professional credentials of MD. The NPI Number for Carl Ray Dettwiler is 1285623819 and holds a License No. M5110 (Idaho).

The current practice location address for Carl Ray Dettwiler is 2517 17Th Sreet, Lewiston, ID and can be reached out via phone at 208-743-4373 and via fax at 208-743-3369.

Location: 2517 17Th Sreet, Lewiston, ID, 83501-6311
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1285623819
Provider Name
Carl Ray Dettwiler
Credential
MD
Provider Entity Type
Individual
Gender
Male
Address
2517 17Th Sreet, Lewiston, ID, 83501-6311
Phone Number
208-743-4373
Fax Number
208-743-3369
Provider Enumeration Date
10/17/2005
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
806979100 05 ID
institution
Provider Business Practice Location Address Details
Address
2517 17Th Sreet
City
Lewiston
State
Idaho
Zip
83501-0001
Phone Number
208-743-4373
Fax Number
208-743-3369
person
Provider Business Mailing Address Details
Address
2517 17Th Sreet
City
Lewiston
State
Idaho
Zip
83501-0001
Phone Number
208-743-4373
Fax Number
208-743-3369
person
Provider's Taxonomy Details 1
Type
Other Service Providers
Classification
Specialist
Speciality
-
Taxonomy
174400000X
License No.
M5110 (Idaho)
Definition
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.
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