Provider Demographics
NPI:1790383768
Name:ETZLER, JOHN WILLIAM (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:WILLIAM
Last Name:ETZLER
Suffix:
Gender:M
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:271 MCCOMB ST
Mailing Address - Street 2:
Mailing Address - City:SARANAC LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12983-1653
Mailing Address - Country:US
Mailing Address - Phone:802-779-2600
Mailing Address - Fax:
Practice Address - Street 1:240 S MAIN ST STE H
Practice Address - Street 2:
Practice Address - City:WOLFEBORO
Practice Address - State:NH
Practice Address - Zip Code:03894-4455
Practice Address - Country:US
Practice Address - Phone:603-569-7690
Practice Address - Fax:603-569-7664
Is Sole Proprietor?:No
Enumeration Date:2020-10-13
Last Update Date:2024-04-17
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant