Clearwater Gastroenterology

NPI #1518205715 in Lewiston, Idaho

Provider Information

NPI Number: 1518205715
Entity Type: Organization
Organization Name: Clearwater Gastroenterology
Primary Specialty: Specialist
Enumeration Date: Jan 22, 2013
Last Updated: Jan 22, 2013

Practice Location

Address: 2517 17TH ST
Address 2: SUITE B
City: Lewiston
State: Idaho
ZIP Code: 83501-6311
Phone: (208) 743-4373

Authorized Official

Name: MR. CARL RAY DETTWILER, M.D.
Title: M.D.
Phone: (208) 743-4373

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Specialist	174400000X	Primary

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