MEDICARE: DR. JOHN DAVID FETZER DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0131X	Foot Surgery Podiatrist	36.002423	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0537460001	OTHER		MEDICARE NSC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194712620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN DAVID FETZER DPM

Provider Business Mailing Address
First Line	:	335 E WATERLOO RD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44319-1218
Country	:	US
Telephone Number	:	330-724-8689
Fax Number	:	330-724-5470

Provider Business Practice Location Address
First Line	:	335 E WATERLOO RD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44319-1218
Country	:	US
Telephone Number	:	330-724-8689
Fax Number	:	330-724-5470

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	08/12/2008

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