Individual
JAMES K DETWILER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
211 NW LARCH AVE, REDMOND, OR 97756-1357
(541) 548-2164
(541) 548-0534
Mailing address
PO BOX 1420, REDMOND, OR 97756-0400
(541) 548-2164
(541) 548-0534
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD09568
OR
207QG0300X
Geriatric Medicine (Family Medicine) Physician
MD09568
OR
2083A0100X
Aerospace Medicine Physician
MD09568
OR
2083X0100X
Occupational Medicine Physician
MD09568
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11129522
CAQH ID
OR
05
—
233692
—
OR
Enumeration date
06/14/2006
Last updated
02/07/2012
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