Healthcare Provider Details

I. General information

NPI: 1477502151
Provider Name (Legal Business Name): STEPHEN PAUL HETZ MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 08/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5005 N. PIEDRAS STREET ATTN: CREDENTIALS OFFICE, RM 10036
EL PASO TX
79920-5001
US

IV. Provider business mailing address

WBAMC, 5005 N. PIEDRAS STREET ATTN: CREDENTIALS OFFICE, RM 10036
EL PASO TX
79920-5001
US

V. Phone/Fax

Practice location:
  • Phone: 915-569-2107
  • Fax: 915-569-1233
Mailing address:
  • Phone: 915-569-2107
  • Fax: 915-569-1233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number28802
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: