Organization Name: | DR DAVID DETMER, MD, PA. |
NPI Number: | 1376866004 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DAVID DETMER (MD) |
Mailing Address: | 1600 Fm 646 N Dickinson |
State: | TX US |
Postal Code: | 77539 |
Phone Number: | 4099254821 |
Fax Number: | |
NPI Enumeration Date: | 03/09/2010 |
NPI Last Update Date: | 03/09/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | G2945 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | TX |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |