Provider Demographics
NPI:1083794622
Name:DETTMER, JOSHUA PAUL (DO)
Entity Type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:PAUL
Last Name:DETTMER
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Gender:M
Credentials:DO
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Mailing Address - Street 1:100 BREWSTER BLVD
Mailing Address - Street 2:NAVAL HOSPITAL
Mailing Address - City:CAMP LEJEU NE
Mailing Address - State:NC
Mailing Address - Zip Code:28547-2538
Mailing Address - Country:US
Mailing Address - Phone:910-450-3095
Mailing Address - Fax:910-450-4558
Practice Address - Street 1:620 JOHN PAUL JONES CIR
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708-2111
Practice Address - Country:US
Practice Address - Phone:757-953-9801
Practice Address - Fax:757-953-8011
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2022-07-21
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Provider Licenses
StateLicense IDTaxonomies
VA0102202094207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease