Provider Demographics
NPI:1316350044
Name:YETTER, MARCUS D (DPM)
Entity type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:D
Last Name:YETTER
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 1:31852 COAST HWY STE 105
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-6765
Mailing Address - Country:US
Mailing Address - Phone:949-499-4534
Mailing Address - Fax:949-499-9877
Practice Address - Street 1:31852 COAST HWY STE 105
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651
Practice Address - Country:US
Practice Address - Phone:949-499-4534
Practice Address - Fax:949-499-9877
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5099213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist