| Doctor Name: | DR. DAVID ELWOOD DETWILER |
| NPI Number: | 1104997600 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | DPM |
| License Number: | 0103000648 |
| Business Practice Address: | 1232 Ty Bluff Road Forest, VA - 245511851 |
| Business Phone Number: | 4345253045 |
| Business Fax Number: | |
| Mailing Address: | 1232 Ty Bluff Road, FOREST |
| State: | VA |
| Postal Code: | 245511851 |
| Phone Number: | 4345253045 |
| Fax Number: | |
| NPI Enumeration Date: | 11/13/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213EP1101X |
| License Number: | 0103000648 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Primary Podiatric Medicine |
| Taxonomy Definition: | |