Individual
CARL RAY DETTWILER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2517 17TH SREET, SUITE B, LEWISTON, ID 83501-0001
(208) 743-4373
(208) 743-3369
Mailing address
2517 17TH ST, SUITE B, LEWISTON, ID 83501-6311
(208) 743-4373
(208) 743-3369
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
M5110
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
806979100
—
ID
Enumeration date
10/17/2005
Last updated
12/16/2025
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