Healthcare Provider Details

I. General information

NPI: 1225081656
Provider Name (Legal Business Name): THOMAS RICHARD VETTER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 03/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 EAST 15TH STREET UNIVERSITY MEDICAL CENTER BRACKENRIDGE
AUSTIN TX
78701
US

IV. Provider business mailing address

1400 BARBARA JORDAN BLVD DPRI SUITE 1.114
AUSTIN TX
78723-3092
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-7000
  • Fax:
Mailing address:
  • Phone: 512-495-5089
  • Fax: 512-495-4944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number01058776
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberQ9071
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01058776
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number28231
License Number StateAL
# 5
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberQ9071
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: