Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 9941 | ND |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 4287 | AK |
NPI | 1245239524 |
---|---|
Provider Name | David Kent Zetterman |
First Address | Fairbanks, AK 99701-4922 |
Second Address | Fairbanks, AK 99701-4922 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2005 |
Last Update Date | 12/12/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1014160 | (05) | AK |
BZ4562155 | DEA (01) | AK |