Individual
DR. DALE T FETROE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1301 EPHRATA, C/O COYOTE RIDGE CORRECTION CENTER, CONNELL, WA 99326
(509) 543-5903
Mailing address
1301 EPHRATA, C/O COYOTE RIDGE CORRECTION CENTER, CONNELL, WA 99326
(509) 543-5903
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD00018950
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080173711
RAILROAD MEDICARE
WA
05
—
1111855
—
WA
05
—
239467
—
OR
Enumeration date
06/28/2005
Last updated
03/22/2011
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