Individual
EDWARD P. DAETWYLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
350 W COLUMBIA ST, SUITE 310, EVANSVILLE, IN 47710-1782
(812) 425-2646
(812) 467-7209
Mailing address
350 W COLUMBIA ST, SUITE 310, EVANSVILLE, IN 47710-1782
(812) 425-2646
(812) 467-7209
Taxonomy
Speciality
Code
Description
License number
State
207YX0007X
Plastic Surgery within the Head & Neck (Otolaryngology) Physician
Primary
01032497A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100078630
—
IN
Enumeration date
02/09/2006
Last updated
12/04/2012
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