Provider Demographics
NPI:1194712620
Name:FETZER, JOHN DAVID (DPM)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DAVID
Last Name:FETZER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:335 E WATERLOO RD
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44319-1218
Mailing Address - Country:US
Mailing Address - Phone:330-724-8689
Mailing Address - Fax:330-724-5470
Practice Address - Street 1:335 E WATERLOO RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44319-1218
Practice Address - Country:US
Practice Address - Phone:330-724-8689
Practice Address - Fax:330-724-5470
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2008-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36.002423213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0537460001OtherMEDICARE NSC
OH0689974Medicaid
OH0689974Medicaid
OHT80657Medicare UPIN