CLEARWATER GASTROENTEROLOGY NPI 1518205715

NPI Information

CLEARWATER GASTROENTEROLOGY is a specialist in Lewiston, ID. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. CLEARWATER GASTROENTEROLOGY NPI is 1518205715. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

2517 17TH ST
SUITE B
LEWISTON, ID
ZIP 83501-311
Phone: (208) 743-4373

The provider's authorized official is Carl Ray Dettwiler .
The authorized official title is M.d. and has the following contact phone number (208) 743-4373.

The CLIA number assigned to this NPI record is 13D2060604 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 1/22/2013 and was last updated on 1/22/2013.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

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