Individual
THOMAS H ETTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
424 YELLOWSTONE AVE STE 250, CODY, WY 82414-9310
(307) 578-2922
(307) 578-2192
Mailing address
424 YELLOWSTONE AVE STE 250, CODY, WY 82414-9310
(307) 578-2922
(307) 578-2192
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
2006003130
MO
208600000X
Surgery Physician
Primary
9334A
WY
208600000X
Surgery Physician
TL2094
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1154562791
—
MO
01
—
12740475
MULTIPLAN
MO
05
—
135178800
—
WY
01
—
28058
GHP
MO
01
—
3032610
UNITED HEALTHCARE
MO
01
—
622086
ANTHEM BLUECROSS BLUESHIELD
MO
01
—
921792
HEALTHLINK INC
MO
01
—
9847314
AETNA
MO
Enumeration date
03/11/2009
Last updated
04/17/2026
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