Individual
DR. DEWEY TODD DETAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1595 CENTRAL AVE, SUMMERVILLE, SC 29483-5529
(843) 212-8080
(843) 789-1521
Mailing address
PO BOX 743070, ATLANTA, GA 30374-3070
(864) 560-4304
(864) 560-4413
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2020-00089
NC
207Q00000X
Family Medicine Physician
483
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004836
—
SC
01
—
SC14336067
MEDICARE PIN
SC
01
—
SC14336084
MEDICARE PIN
SC
01
—
SC1433J577
MEDICARE PIN
SC
Enumeration date
08/29/2006
Last updated
06/09/2021
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