Robert Franklin Dettmer Sr., M.D.
Individual provider Active NPI General Practice Physician · Ironton, MO
NPI 1194074302 · NPPES record last updated Sep 4, 2012
Key facts
- NPI
- 1194074302
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Physician 208D00000X
- License
- 28191M.D. (MO)
- Practice address
- 3 Longwood Lane
Ironton, MO 63650-0307 - Phone
- (573) 546-2741
- Fax
- (573) 546-2741
- NPI assigned
- Sep 4, 2012
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 28191M.D. | MO | MD | General Practice Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Physician | 208D00000X | 28191M.D. | MO | Yes |
Addresses
Primary practice location
3 Longwood Lane
Ironton, MO 63650-0307
Mailing address
PO Box 307
#3 Longwood Lane
Ironton, MO 63650-0307
Phone (573) 546-2741
Other providers in Ironton, MO
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- Rebecca Barron
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All providers in Ironton, MO · General Practice Physician in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 4, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.