Provider Demographics
NPI:1548343841
Name:DETRO, JOHN FITZGERALD (PA-C)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:FITZGERALD
Last Name:DETRO
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:7950 MARTIN LOOP
Mailing Address - Street 2:MARTIN ARMY COMMUNITY HOSPITAL
Mailing Address - City:FORT BENNING
Mailing Address - State:GA
Mailing Address - Zip Code:31905-5647
Mailing Address - Country:US
Mailing Address - Phone:706-545-3958
Mailing Address - Fax:706-545-5762
Practice Address - Street 1:7950 MARTIN LOOP
Practice Address - Street 2:MARTIN ARMY COMMUNITY HOSPITAL
Practice Address - City:FORT BENNING
Practice Address - State:GA
Practice Address - Zip Code:31905-5647
Practice Address - Country:US
Practice Address - Phone:706-545-3958
Practice Address - Fax:706-545-5762
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical