Individual
THOMAS CRAIG DETWEILER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
965 ELLENDALE DR, MEDFORD, OR 97504
(541) 732-6000
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
(541) 732-6000
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
039504L
PA
207R00000X
Internal Medicine Physician
Primary
MD164287
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500670934
—
OR
Enumeration date
06/05/2006
Last updated
12/20/2019
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