Provider Demographics
NPI:1760573745
Name:ETCHEVERRY, JOHN LOUIS (DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:LOUIS
Last Name:ETCHEVERRY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2400 BAHAMAS DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0745
Mailing Address - Country:US
Mailing Address - Phone:661-328-2323
Mailing Address - Fax:661-328-5573
Practice Address - Street 1:2400 BAHAMAS DR
Practice Address - Street 2:SUITE 200
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0745
Practice Address - Country:US
Practice Address - Phone:661-328-2323
Practice Address - Fax:661-328-5573
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAE4099213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00904698OtherRAILROAD MEDICARE
000E40990OtherBLUE SHIELD
000E40990OtherBLUE SHIELD
U93496Medicare UPIN