Individual
SUSAN P DETWILER
Active
Individual
SUSAN P DETWILER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
G75321
CA
207ND0900X
Dermatopathology Physician
Primary
G75321
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G753212
—
CA
01
—
00G753213
BLUE SHIELD OF CA
CA
01
—
00G753214
BLUE SHIELD OF CA
CA
01
—
070017499
MEDICARE RAILROAD
CA
05
—
LAB25100F
—
CA
Enumeration date
07/07/2006
Last updated
04/28/2009
Update your record
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