Individual
DR. JEREMY R ETZKORN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3600 SPRUCE STREET, 2 MALONEY BLDG, PHILADELPHIA, PA 19104
(215) 662-2737
Mailing address
3600 SPRUCE STREET, 2 MALONEY BLDG, PHILADELPHIA, PA 19104
(215) 662-2737
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
MD451783
PA
207N00000X
Dermatology Physician
ME110688
FL
207ND0101X
MOHS-Micrographic Surgery Physician
ME110688
FL
207NS0135X
Procedural Dermatology Physician
ME110688
FL
390200000X
Student in an Organized Health Care Education/Training Program
TRN122223
FL
Other
Enumeration date
06/10/2008
Last updated
05/15/2014
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