# DR. SAM ALLEN DETWILER

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1871025767
- **Gender:** Man
- **Credential:** MD, ATC

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | 94-11926 | KS | Yes |
| 2255A2300X | Athletic Trainer | AT8023 | TX | — |

## Other

- **Enumeration date:** 03/30/2017
- **Last updated:** 06/13/2024