Edward P. Daetwyler, M.D.

Primary specialty

Plastic Surgery within the Head & Neck (Otolaryngology) PhysicianTaxonomy code 207YX0007X

License

01032497A Issued in IN

Practice address

350 W Columbia St
Suite 310
Evansville, IN 47710-1782

Phone

(812) 425-2646

Fax

(812) 467-7209

NPI assigned

Feb 9, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139443200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1354579200000",
    "number": "1669445722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "350 W COLUMBIA ST",
            "address_2": "SUITE 310",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477101782",
            "telephone_number": "812-425-2646",
            "fax_number": "812-467-7209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 W COLUMBIA ST",
            "address_2": "SUITE 310",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477101782",
            "telephone_number": "812-425-2646",
            "fax_number": "812-467-7209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAETWYLER",
        "first_name": "EDWARD",
        "middle_name": "P.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-09",
        "last_updated": "2012-12-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207YX0007X",
            "taxonomy_group": "",
            "desc": "Otolaryngology, Plastic Surgery within the Head & Neck",
            "state": "IN",
            "license": "01032497A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100078630",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Angela Isabell Czup, MD
• D Express Lane
• Reshma D'Mello, M.D.
• Benjamin Dabney
• Jaquela Dade, RBT
• Riley Elizabeth Dagley
• Gautam Dagur, MD, PHD
• Cindy Nichole Daily
• Heather Daily, RN
• Paul T Daines, D.P.M.

• Plastic Surgery within the Head & Neck (Otolaryngology) Physician in Evansville, IN
• Providers in Evansville, IN by specialty
• Plastic Surgery within the Head & Neck (Otolaryngology) Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 4, 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.

Verify at the official NPI Registry.