Individual
JEFFREY GASTON DETWEILER
Active
Individual
JEFFREY GASTON DETWEILER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207ZD0900X
Dermatopathology (Pathology) Physician
Primary
H5867
TX
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
H5867
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
132426106
—
TX
01
—
220018477
RAILROAD MEDICARE
TX
01
—
83P494
BCBS
TX
Enumeration date
07/18/2006
Last updated
03/23/2015
Update your record
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