Individual
DR. MARVIN R FETTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1300 ANNE ST NW, BEMIDJI, MN 56601-5103
(218) 751-9746
(218) 759-0620
Mailing address
1300 ANNE ST NW, BEMIDJI, MN 56601-5103
(218) 751-9746
(218) 759-0620
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
036-045536
IL
207X00000X
Orthopaedic Surgery Physician
39401-020
WI
207X00000X
Orthopaedic Surgery Physician
54685
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
03604536
—
IL
05
—
34444000
—
WI
Enumeration date
08/17/2005
Last updated
05/05/2014
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