NPI 1518205715

Clearwater Gastroenterology

Organisation Specialist Lewiston, ID

Practice location

Address: 2517 17th St Suite B, Lewiston, ID 83501-6311
Phone: (208) 743-4373

Authorised official

Name: Carl Ray Dettwiler
Title: M.D.
Phone: (208) 743-4373

Registered specialties

Specialist Primary

Other Service Providers Taxonomy 174400000X Licence M5110 (ID)

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Registry record

NPI: 1518205715
Entity type: Organization
NPI issued: 22 Jan 2013
Record last updated: 22 Jan 2013

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.