| Entity Name: | JOHN A. FETCHERO, JR., D.O., P.A. |
| Jurisdiction: | FLORIDA |
| Filing Type: | Domestic Profit |
| Status: | Inactive |
| Date Filed: | 21 Apr 2000 (25 years ago) |
| Date of dissolution: | 23 Sep 2016 (8 years ago) |
| Last Event: | ADMIN DISSOLUTION FOR ANNUAL REPORT |
| Event Date Filed: | 23 Sep 2016 (8 years ago) |
| Document Number: | P00000040375 |
| FEI/EIN Number | 593645084 |
| Address: | 2862 Country Club Blvd, Orange Park, FL, 32073, US |
| Mail Address: | 2862 COUNTRY CLUB BLVD., ORANGE PARK, FL, 32073 |
| ZIP code: | 32073 |
| County: | Clay |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1457397499 | 2006-06-20 | 2010-09-30 | 2862 COUNTRY CLUB BLVD, ORANGE PARK, FL, 320735728, US | 1542 KINGSLEY AVE STE 140, ORANGE PARK, FL, 320734547, US | |||||||||||||||||||||
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| Phone | +1 904-278-3820 |
| Fax | 9042783849 |
Authorized person
| Name | JOHN ANTHONY FETCHERO JR. |
| Role | PRESIDENT |
| Phone | 9042783820 |
Taxonomy
| Taxonomy Code | 207YX0905X - Otolaryngology/Facial Plastic Surgery Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 048447400 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| FETCHERO JOHN A | Agent | 2862 COUNTRY CLUB BLVD, ORANGE PARK, FL, 32073 |
| Name | Role | Address |
|---|---|---|
| FETCHERO JOHN A | President | 2862 COUNTRY CLUB BLVD, ORANGE PARK, FL, 32073 |
| Name | Role | Address |
|---|---|---|
| FETCHERO WYNONA A | Vice President | 2862 COUNTRY CLUB BLVD, ORANGE PARK, FL, 32073 |
| Event Type | Filed Date | Value | Description |
|---|---|---|---|
| ADMIN DISSOLUTION FOR ANNUAL REPORT | 2016-09-23 | No data | No data |
| CHANGE OF PRINCIPAL ADDRESS | 2015-01-15 | 2862 Country Club Blvd, Orange Park, FL 32073 | No data |
| REGISTERED AGENT ADDRESS CHANGED | 2001-01-23 | 2862 COUNTRY CLUB BLVD, ORANGE PARK, FL 32073 | No data |
| CHANGE OF MAILING ADDRESS | 2000-06-27 | 2862 Country Club Blvd, Orange Park, FL 32073 | No data |
| AMENDMENT | 2000-06-12 | No data | No data |
| REGISTERED AGENT NAME CHANGED | 2000-06-12 | FETCHERO, JOHN AJR. | No data |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2015-01-15 |
| ANNUAL REPORT | 2014-01-14 |
| ANNUAL REPORT | 2013-02-19 |
| ANNUAL REPORT | 2012-01-05 |
| ANNUAL REPORT | 2011-02-17 |
| ANNUAL REPORT | 2010-01-06 |
| ANNUAL REPORT | 2009-02-13 |
| ANNUAL REPORT | 2008-01-06 |
| ANNUAL REPORT | 2007-01-07 |
| ANNUAL REPORT | 2006-02-12 |
Date of last update: 02 Feb 2025
Sources: Florida Department of State
