Provider Demographics
NPI:1194074302
Name:DETTMER, ROBERT FRANKLIN SR (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:FRANKLIN
Last Name:DETTMER
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:#3 LONGWOOD LANE
Mailing Address - City:IRONTON
Mailing Address - State:MO
Mailing Address - Zip Code:63650-0307
Mailing Address - Country:US
Mailing Address - Phone:573-546-2741
Mailing Address - Fax:573-546-2741
Practice Address - Street 1:3 LONGWOOD LANE
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:MO
Practice Address - Zip Code:63650-0307
Practice Address - Country:US
Practice Address - Phone:573-546-2741
Practice Address - Fax:573-546-2741
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-04
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO28191M.D.208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice