Individual
DAVID L TETRICK
Active
Individual
DAVID L TETRICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01035208A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000659374
ANTHEM
IN
01
—
000000659797
ANTHEM
IN
05
—
100335770
—
IN
Enumeration date
07/27/2006
Last updated
11/27/2023
Update your record
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