ALEX DETWILER, M.D., P.A. (NPI# 1073601118) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1073601118 |
| Entity Type | Organization |
| Organization Name | ALEX DETWILER, M.D., P.A. |
| Practice Address |
1000 S Beckham Ave Tyler TX 75701-1908 |
| Mailing Address |
Po Box 132601 Tyler TX 75713-2601 |
| Practice Telephone | 9035217838 |
| Mailing Telephone | 9035217838 |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2008-02-28 |
| Authorized Official Name | DR. ALEKSANDRA OLSSON-DETWILER (OWNER) |
| Authorized Official Telephone | 9035217838 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | L1685 | TX | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| TX | BCBS | 0056LZ | 01 |
| TX | RAILROAD MEDICARE | DC1535 | 01 |
| Street Address |
1000 S BECKHAM AVE |
| City | TYLER |
| State | TX |
| Zip Code | 75701-1908 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740280510 | Aleksandra Olsson-detwiler | Internal Medicine | 1000 S Beckham Ave, Tyler, TX 75701-1908 | 2005-07-22 |
| 1831706431 | Kalana Sanders | Registered Nurse | 1000 S Beckham Ave, Tyler, TX 75701-1908 | 2020-09-28 |
| 1992333975 | Graceanne M. Dimon | Physical Therapist | 1000 S Beckham Ave, Tyler, TX 75701-1908 | 2020-03-27 |
| 1760021976 | Gerardo Tapia Hernandez | Nurse Practitioner | 1000 S Beckham Ave, Tyler, TX 75701-1908 | 2020-01-06 |
| 1861950057 | Brittany Mason Ferguson | Nurse Practitioner | 1000 S Beckham Ave, Tyler, TX 75701-1908 | 2019-03-06 |
| 1255801189 | Shane Ashley Correa | Nurse Practitioner | 1000 S Beckham Ave, Tyler, TX 75701-1908 | 2018-12-04 |
| 1174000962 | David Matthew Burkland | Nurse Practitioner | 1000 S Beckham Ave, Tyler, TX 75701-1908 | 2018-07-24 |
| 1598251209 | Kelsey Rene Morton | Nurse Practitioner | 1000 S Beckham Ave, Tyler, TX 75701-1908 | 2018-07-05 |
| 1063915916 | Tyler Regional Hospital LLC | Surgery | 1000 S Beckham Ave, Tyler, TX 75701-1908 | 2018-03-16 |
| 1437650264 | Tyler Regional Hospital LLC | Nurse Anesthetist, Certified Registered | 1000 S Beckham Ave, Tyler, TX 75701-1908 | 2018-02-27 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962057059 | Gonzalo Fernandez | Physical Therapy Assistant | 753 S Beckham Ave, Tyler, TX 75701 | 2019-08-06 |
| 1215422654 | Adrianna Bussell | Nurse Practitioner | 1000 South Beckham, Tyler, TX 75701 | 2018-06-28 |
| 1285128017 | Idowu Akintokunbo Akinyele | Dentist | Aspen Dental, 4164 S Broadway Ave, Tyler, TX 75701 | 2018-06-15 |
| 1992208912 | Heather Renee Vancleave | Occupational Therapy Assistant | 1228 Louann Lane, Tyler, TX 75701 | 2018-03-15 |
| 1497260533 | Smile Workshop Mckinney, Pllc | Dentist | 301 N. Custer Rd, Mckinney, TX 75701 | 2017-12-12 |
| 1396266441 | Eye Surgery Center of East Texas, Pllc | Clinic/Center | 2448 E 5th St, Tyler, TX 75701 | 2017-06-29 |
| 1962936369 | Collins Complete Family Care | Nurse Practitioner | 1910 E Se Loop 323 # 176, Tyler, TX 75701 | 2017-04-12 |
| 1386187052 | Fellowship Health Team LLC | Home Health | 1124 S Fleishel Ave, Tyler, TX 75701 | 2016-11-29 |
| 1205382454 | Brenton Robinson | Nurse Practitioner | 1100 East Lake St, 160, Tyler, TX 75701 | 2016-08-28 |
| 1851846208 | Care First Pharmacy, LLC | Pharmacy | 1910 Roseland Blvd A, Tyler, TX 75701 | 2016-08-15 |
| Find all providers in zip 75701 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| 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. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1144572512 | Parent Services Center, Inc. | Specialist | 4411 Old Bullard Rd Ste 602, Tyler, TX 75703-1215 | 2012-10-10 |
| 1093032880 | Misty M Bridges | Specialist | 106 E Heritage Dr Ste 5e, Tyler, TX 75703-5112 | 2010-05-03 |
| 1972820611 | Leah F Woodruff | Specialist | 201 Winchester Dr, Tyler, TX 75701-8847 | 2010-04-20 |
| 1457587248 | Marissa Borromeo | Specialist | 4914 Inverness Dr, Tyler, TX 75703-2604 | 2009-06-07 |
| 1265613889 | Appletree Pediatrics, P.a. | Specialist | 1306 Doctors Dr, Tyler, TX 75701-2262 | 2007-11-26 |
| 1093803116 | Robert L. Boyne, M.d., P.a. | Specialist | 700 Olympic Plaza Cir Ste 912, Tyler, TX 75701-1955 | 2006-10-11 |
| 1760578835 | Jeffrey P. Smith | Specialist | 4801 Troup Hwy S, Suite 301, Tyler, TX 75703 | 2006-10-05 |
| 1952409377 | Rosenfield, Md. Pa | Specialist | 1305 Dr Drive, Tyler, TX 75701-3343 | 2006-09-20 |
| 1275571861 | Joseph Lynn Prud'homme Sr. | Specialist | 1015 E Idel St, Tyler, TX 75701-2025 | 2006-06-03 |
| 1225023070 | Adagio Dermatology and Aesthetics, P.a. | Specialist | 455 Rice Road, Ste. 104, Tyler, TX 75703-3604 | 2005-09-19 |
| Find all providers in TYLER | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.