Organization
ALEX DETWILER, M.D., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALEKSANDRA OLSSON-DETWILER M.D. (OWNER)
(903) 521-7838
Entity
Organization
Contact information
Practice address
1000 S BECKHAM AVE, TYLER, TX 75701-1908
(903) 521-7838
Mailing address
PO BOX 132601, TYLER, TX 75713-2601
(903) 521-7838
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
L1685
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0056LZ
BCBS
TX
01
—
DC1535
RAILROAD MEDICARE
TX
Enumeration date
10/11/2006
Last updated
02/28/2008
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