Detweiler, Jeffrey Gaston

Detweiler, Jeffrey Gaston is an individual health care provider with primary practice located at 6100 Harris Parkway , Fort Worth TX 76132-4126. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Dermatopathology, Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology. Allopathic & Osteopathic Physicians / Dermatopathology is his primary health care specialty. Detweiler, Jeffrey Gaston can be contacted via phone (214) 638-2000.

Contact Information

Primary practice address
6100 Harris Parkway Fort Worth TX 76132-4126
Phone: (214) 638-2000
Fax: (214) 237-1864
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatopathology 207ZD0900X H5867 Texas
Allopathic & Osteopathic Physicians / Anatomic Pathology & Clinical Pathology 207ZP0102X H5867 Texas

Profile Details

NPI number 1215955950
LBN Legal business name Detweiler, Jeffrey Gaston
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 18th, 2006
Last updated Mar 23rd, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1215955950 NPPES
Texas Other 220018477 RAILROAD MEDICARE
Texas Other 83P494 RAILROAD MEDICARE
Texas MEDICAID 132426106 RAILROAD MEDICARE

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