Individual
GARY LEE ETTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
855 MONTGOMERY ST, FORT WORTH, TX 76107-2553
(817) 735-2400
Mailing address
PO BOX 99335, FORT WORTH, TX 76199-0335
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
F6608
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
135567912
—
TX
01
—
8U1293
BCBS
TX
01
—
P00415557
MEDICARE RAILROAD
TX
Enumeration date
05/17/2006
Last updated
09/27/2011
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