Active NPI
David Elwood Detwiler, DPM
- Primary Podiatric Medicine Podiatrist
- Forest, VA
National Provider Identifier
1104997600
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Primary Podiatric Medicine Podiatrist
- License
- 0103000648
- Practice address
- 1232 Ty Bluff Road
Forest, VA 24551-1851 - Phone
- (434) 525-3045
- NPI assigned
- Nov 13, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Podiatric Medicine Podiatrist | 213EP1101X | 0103000648 | VA | Primary |
Addresses
Primary practice location
1232 Ty Bluff Road
Forest, VA 24551-1851
Mailing address
1232 Ty Bluff Road
Forest, VA 24551-1851
Phone (434) 525-3045
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0103000648 | VA | MD | Primary Podiatric Medicine Podiatrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163376000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1104997600",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1232 TY BLUFF ROAD",
"city": "FOREST",
"state": "VA",
"postal_code": "245511851",
"telephone_number": "434-525-3045"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1232 TY BLUFF ROAD",
"city": "FOREST",
"state": "VA",
"postal_code": "245511851",
"telephone_number": "434-525-3045"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DETWILER",
"first_name": "DAVID",
"middle_name": "ELWOOD",
"name_prefix": "Dr.",
"credential": "DPM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-13",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "213EP1101X",
"taxonomy_group": "",
"desc": "Podiatrist, Primary Podiatric Medicine",
"state": "VA",
"license": "0103000648",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Forest, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.