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General NPI Number Information
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NPI Number | 1982736435
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Entity Type | Organization
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Legal Business Name | JOSEPH P. FETZEK M.D., P.A.
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Dates
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Enumeration Date | 03/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10222 SUMMERWIND DR
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City | BOISE
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State | ID
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Zip | 83704-3950
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Country | US
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Telephone | 208-377-3427
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Fax |
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Provider Business Mailing Address
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Address Line | 10222 SUMMERWIND DR
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City | BOISE
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State | ID
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Zip | 83704-3950
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Country | US
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Telephone | 208-377-3427
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOSEPH PATRICK FETZEK
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Credential | M.D.
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Telephone | 208-377-3427
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | M3365
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License Number State | ID
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