William Russell Detten D.O.

NPI 1033229935 - Family Medicine - 207Q00000X

NPI Details
NPI 1033229935
Gender Male
Enumeration Date 08/30/2006
Last Updated 11/12/2012
Entity Type Individual
Active Over 10 years ago
Practice Location
1530 E REPUBLIC RD
SPRINGFIELD MO, 65804-6530, US
Phone (417) 269-1362
Fax (417) 269-1372
Business Location
PO BOX 4046
SPRINGFIELD MO, 65808-4046, US
Phone (417) 269-1362
Fax (417) 269-1372
Toxanomy
Taxonomy Code 207Q00000X
License State Missouri
License Number R4P90
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According to our database, Dr. William Russell Detten D.O. NPI is 1033229935, taxonomy code is 207Q00000X and license number is R4P90, license state is located at Missouri. William Russell Detten D.O. physically located at 1530 E Republic Rd, Springfield MO, 65804-6530. NPI Number William Russell Detten D.O. has the Individual type.

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1033229935 NPI number is provided on an as is basis without warranty of any kind. 1033229935 is maintained by the National Plan & Provider Enumeration System. The contents of William Russell Detten D.O. are for informational purposes only.