Provider Demographics
NPI:1831519107
Name:DETWILER, ALEX NORMAN (DO)
Entity type:Individual
Prefix:DR
First Name:ALEX
Middle Name:NORMAN
Last Name:DETWILER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 W 6TH AVE STE 207
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-4381
Mailing Address - Country:US
Mailing Address - Phone:405-707-0900
Mailing Address - Fax:405-707-3363
Practice Address - Street 1:1301 W 6TH AVE STE 207
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-4381
Practice Address - Country:US
Practice Address - Phone:405-707-0900
Practice Address - Fax:405-707-3363
Is Sole Proprietor?:No
Enumeration Date:2014-04-24
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5730207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK5730OtherORTHOPEDIC SURGERY