Individual
JOHN DAVID DEETJEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1201 FAIRMOUNT AVE, FORT WORTH, TX 76104-4215
(817) 335-5288
(817) 338-0927
Mailing address
6100 HARRIS PKWY STE 285, FORT WORTH, TX 76132-4127
(817) 263-5864
(817) 394-6294
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Enumeration date
05/09/2023
Last updated
05/09/2023
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