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General NPI Number Information
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NPI Number | 1689842445
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Entity Type | Organization
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Legal Business Name | JOHN A ICETON MD PA
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Dates
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Enumeration Date | 02/14/2008
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2927 PARK PLAZA LN
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City | PORT ARTHUR
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State | TX
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Zip | 77642-5516
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Country | US
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Telephone | 409-983-5178
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Fax |
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Provider Business Mailing Address
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Address Line | 2927 PARK PLAZA LN
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City | PORT ARTHUR
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State | TX
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Zip | 77642-5516
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Country | US
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Telephone | 409-983-5178
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Fax |
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | DR. JOHN A ICETON
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Credential |
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Telephone | 409-983-5178
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | H6857
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License Number State | TX
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