Individual
MR. JACOB C FETZER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
30 N 1900 E RM 4A100, SALT LAKE CITY, UT 84132-0002
(801) 585-7676
Mailing address
762 E 500 S, SALT LAKE CITY, UT 84102-2906
(801) 574-6455
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
8421267-1206
UT
Other
Enumeration date
12/04/2012
Last updated
11/09/2021
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