Provider Demographics
NPI:1770625246
Name:DETTMER, ROBERT FRANKLIN
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:FRANKLIN
Last Name:DETTMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 442
Mailing Address - Street 2:BOX 885
Mailing Address - City:HEIDELBERG
Mailing Address - State:GERMANY
Mailing Address - Zip Code:APO 09042
Mailing Address - Country:DE
Mailing Address - Phone:06221-650-8669
Mailing Address - Fax:
Practice Address - Street 1:CMR 442
Practice Address - Street 2:BOX 885
Practice Address - City:HEIDELBERG
Practice Address - State:GERMANY
Practice Address - Zip Code:APO 09042
Practice Address - Country:DE
Practice Address - Phone:06221-650-8669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0105597163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator