Provider Demographics
NPI:1386686020
Name:FETT DESMOND, DEBRA D (MD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:D
Last Name:FETT DESMOND
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:D
Other - Last Name:FETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:14071 METROPOLIS AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4330
Mailing Address - Country:US
Mailing Address - Phone:239-694-7546
Mailing Address - Fax:239-694-1571
Practice Address - Street 1:14071 METROPOLIS AVE STE 2
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33912-4330
Practice Address - Country:US
Practice Address - Phone:239-694-7546
Practice Address - Fax:239-694-1571
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2021-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 68928207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology