Provider Demographics
NPI:1477528313
Name:FJERSTAD, JOHN E (DPM)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:E
Last Name:FJERSTAD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:JOHN
Other - Middle Name:E
Other - Last Name:FJERSTAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:1967 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MCKINLEYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95519-3605
Mailing Address - Country:US
Mailing Address - Phone:707-840-0226
Mailing Address - Fax:707-840-0422
Practice Address - Street 1:1967 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MCKINLEYVILLE
Practice Address - State:CA
Practice Address - Zip Code:95519-3605
Practice Address - Country:US
Practice Address - Phone:707-840-0226
Practice Address - Fax:707-840-0422
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP00335213ES0103X
CAE4316213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU87482Medicare UPIN
CA4439100002Medicare NSC
OR4439100001Medicare NSC
ORR1180177Medicare ID - Type UnspecifiedBROOKINGS
CA000E43160Medicare ID - Type UnspecifiedCRESCENT CITY
CAU87482Medicare UPIN