Healthcare Provider Details

I. General information

NPI: 1245239524
Provider Name (Legal Business Name): DAVID KENT ZETTERMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 NOBLE ST
FAIRBANKS AK
99701-4922
US

IV. Provider business mailing address

1001 NOBLE ST
FAIRBANKS AK
99701-4922
US

V. Phone/Fax

Practice location:
  • Phone: 907-459-3500
  • Fax: 907-459-3588
Mailing address:
  • Phone: 907-459-3500
  • Fax: 907-459-3588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9941
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number4287
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: