Provider Demographics
NPI:1699113472
Name:ETTER, JUSTIN DAVID (DO)
Entity type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:DAVID
Last Name:ETTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:531 FAUNCE CORNER RD
Mailing Address - Street 2:
Mailing Address - City:DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747-1242
Mailing Address - Country:US
Mailing Address - Phone:508-996-3991
Mailing Address - Fax:508-961-2993
Practice Address - Street 1:531 FAUNCE CORNER RD
Practice Address - Street 2:
Practice Address - City:DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02747-1242
Practice Address - Country:US
Practice Address - Phone:508-996-3991
Practice Address - Fax:508-961-2993
Is Sole Proprietor?:No
Enumeration Date:2013-06-13
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA265129207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine