Individual
BRUCE L FETTERMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7600 WOLF RIVER BLVD, SUITE 220, GERMANTOWN, TN 38138-1785
(901) 755-5300
(901) 756-0196
Mailing address
PO BOX 2757, CORDOVA, TN 38088-2757
(901) 755-5300
(901) 753-9659
Taxonomy
Speciality
Code
Description
License number
State
207YX0901X
Otology & Neurotology Physician
Primary
MD29959
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3818743
—
TN
01
—
4108473
BC
TN
01
—
97772
BC
AR
01
—
P00238841
RR MEDICARE
TN
Enumeration date
08/21/2006
Last updated
12/17/2020
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