Organization
CLEARWATER GASTROENTEROLOGY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CARL RAY DETTWILER M.D. (M.D.)
(208) 743-4373
Entity
Organization
Contact information
Practice address
2517 17TH ST, SUITE B, LEWISTON, ID 83501-6311
(208) 743-4373
Mailing address
2517 17TH ST, SUITE B, LEWISTON, ID 83501-6311
(208) 743-4373
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
M5110
ID
Other
Enumeration date
01/22/2013
Last updated
01/22/2013
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