Basic Information
| Provider Information | |||||||||
| NPI: | 1598711756 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ZETTER | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1029 MEDICAL CENTER CIR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MAYFIELD | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420661189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2702670051 | ||||||||
| FaxNumber: | 2702514546 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 STATE ROUTE 80 E | ||||||||
| Address2: | |||||||||
| City: | ARLINGTON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 420219016 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2702670051 | ||||||||
| FaxNumber: | 2702514546 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/26/2006 | ||||||||
| LastUpdateDate: | 03/02/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/02/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 31625 | KY | N | Allopathic & Osteopathic Physicians | Family Medicine | 208D00000X | 31625 | KY | Y | Allopathic & Osteopathic Physicians | General Practice |
ID Information
| ID | Type | State | Issuer | Description | 010054137 | 01 | KY | MEDICARE RAILROAD | OTHER | 64316250 | 05 | KY | MEDICAID |