MEDICARE: MR. SONNY JOHN STETSON M.D., CSA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	246ZS0410X	Surgical Technologist	12-181	TX
2	246ZC0007X	Surgical Assistant	12-181	TX

General Provider Information

NPI Number	:	1700221967
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SONNY JOHN STETSON M.D., CSA

Provider Business Mailing Address
First Line	:	3524 OMEARA DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-5558
Country	:	US
Telephone Number	:	713-909-9390
Fax Number	:

Provider Business Practice Location Address
First Line	:	3524 OMEARA DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77025-5558
Country	:	US
Telephone Number	:	713-909-9390
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/01/2013
Last Update Date	:	09/11/2013

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