Provider Demographics
NPI:1740165679
Name:MS WOUND CARE PC
Entity type:Organization
Organization Name:MS WOUND CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCUS
Authorized Official - Middle Name:
Authorized Official - Last Name:YETTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:480-390-8436
Mailing Address - Street 1:19 CHAPITAL
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-9311
Mailing Address - Country:US
Mailing Address - Phone:949-627-3272
Mailing Address - Fax:949-499-9877
Practice Address - Street 1:2247 E MALLORY CIR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85213-1413
Practice Address - Country:US
Practice Address - Phone:949-627-3272
Practice Address - Fax:949-499-9877
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-08
Last Update Date:2025-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty