Etter, Gary Lee

Etter, Gary Lee is an individual health care provider with primary practice located at 855 Montgomery St , Fort Worth TX 76107-2553. He recently has only one registered license in Allopathic & Osteopathic Physicians / Psychiatry, which is considered as his primary health care specialty. Etter, Gary Lee can be contacted via phone (817) 735-2400.

Contact Information

Primary practice address
855 Montgomery St Fort Worth TX 76107-2553
Phone: (817) 735-2400
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Psychiatry 2084P0800X F6608 Texas

Profile Details

NPI number 1427000264
LBN Legal business name Etter, Gary Lee
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 17th, 2006
Last updated Sep 27th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1427000264 NPPES
Texas Other 8U1293 BCBS
Texas Other P00415557 BCBS
Texas MEDICAID 135567912 BCBS

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