Individual
MARY H FETH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
320 JEFFERSON ST, WASHINGTON, MO 63090-2634
(636) 432-1560
(636) 432-1563
Mailing address
320 JEFFERSON ST, WASHINGTON, MO 63090-2634
(636) 432-1560
(636) 432-1563
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD106702
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
207801309
—
MO
Enumeration date
06/21/2005
Last updated
02/28/2013
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