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Individual

THOMAS H HETRICK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
7715 OAK RIDGE HWY, KNOXVILLE, TN 37931-3338
(865) 694-0376
Mailing address
1225 E WEISGARBER RD, SUITE 200, KNOXVILLE, TN 37909-2604
(865) 584-4747

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
09122
TN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
3187500
TN
01
3706633
MEDICARE GROUP
TN
01
990011726
RR MEDICARE PIN
TN
Enumeration date
06/19/2006
Last updated
03/17/2009
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