Active NPI
Robert Wayne Dettmer, M.D.
- Nephrology Physician
- Fort Wayne, IN
National Provider Identifier
1326319724
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- License
- 01022140A
- Practice address
- 2935 Ambleside Way
Fort Wayne, IN 46804-2443 - Phone
- (260) 459-7657
- Fax
- (260) 459-7658
- NPI assigned
- Jan 18, 2012
- 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 |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | 01022140A | IN | Primary |
Addresses
Primary practice location
2935 Ambleside Way
Fort Wayne, IN 46804-2443
Mailing address
2935 Ambleside Way
Fort Wayne, IN 46804-2443
Phone (260) 459-7657
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)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01022140A | IN | MD | Nephrology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1326844800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1326844800000",
"number": "1326319724",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2935 AMBLESIDE WAY",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468042443",
"telephone_number": "260-459-7657",
"fax_number": "260-459-7658"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2935 AMBLESIDE WAY",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468042443",
"telephone_number": "260-459-7657",
"fax_number": "260-459-7658"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DETTMER",
"first_name": "ROBERT",
"middle_name": "WAYNE",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-01-18",
"last_updated": "2012-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "IN",
"license": "01022140A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.