Individual
JOHN EDGAR FETTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6565 FANNIN ST, SUITE B452, HOUSTON, TX 77030-2703
(713) 441-3620
(713) 790-2082
Mailing address
6565 FANNIN ST, SUITE B452, HOUSTON, TX 77030-2703
(713) 441-3620
(713) 790-2082
Taxonomy
Speciality
Code
Description
License number
State
207RP1001X
Pulmonary Disease Physician
56823
TN
208600000X
Surgery Physician
N3028
TX
2086S0102X
Surgical Critical Care Physician
Primary
N3028
TX
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
41164
MN
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
N3028
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
202518300
—
MN
05
—
203934901
—
TX
05
—
203934902
—
TX
05
—
203934903
—
TX
05
—
32494500
—
WI
01
—
8DY860
BLUE CROSS BLUE SHIELD
TX
01
—
8W4777
BLUE CROSS BLUE SHIELD
TX
01
—
P00759962
MEDICARE RAILROAD
TX
01
—
P01030486
RR MEDICARE
TX
01
—
P01254102
MEDICARE RR
TX
Enumeration date
07/06/2006
Last updated
02/15/2018
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