Provider Demographics
NPI:1598711756
Name:ZETTER, DAVID R (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:R
Last Name:ZETTER
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:PO BOX 159
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:42021-0159
Mailing Address - Country:US
Mailing Address - Phone:270-267-0051
Mailing Address - Fax:270-655-5900
Practice Address - Street 1:100 STATE ROUTE 80 E
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:KY
Practice Address - Zip Code:42021-9016
Practice Address - Country:US
Practice Address - Phone:270-267-0051
Practice Address - Fax:270-251-4546
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-26
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY31625207Q00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64316250Medicaid
KY010054137OtherMEDICARE RAILROAD
KYG18934Medicare UPIN
KY1601401Medicare ID - Type Unspecified