Provider Demographics
NPI:1285648626
Name:FETSCH, CLAYTON DALE (MD)
Entity Type:Individual
Prefix:DR
First Name:CLAYTON
Middle Name:DALE
Last Name:FETSCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:MCPHERSON
Mailing Address - State:KS
Mailing Address - Zip Code:67460-2326
Mailing Address - Country:US
Mailing Address - Phone:620-241-7400
Mailing Address - Fax:620-798-2613
Practice Address - Street 1:1000 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MCPHERSON
Practice Address - State:KS
Practice Address - Zip Code:67460-2326
Practice Address - Country:US
Practice Address - Phone:620-241-7400
Practice Address - Fax:620-798-2613
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS30350208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200407470AMedicaid
KSP00419734OtherRAILROAD MEDICARE
KSI59974Medicare UPIN
KS200407470AMedicaid