Provider Demographics
NPI:1093924714
Name:FLETCHER, SOPHIE (MD)
Entity Type:Individual
Prefix:
First Name:SOPHIE
Middle Name:
Last Name:FLETCHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6560 FANNIN
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030
Mailing Address - Country:US
Mailing Address - Phone:713-798-4637
Mailing Address - Fax:
Practice Address - Street 1:6560 FANNIN
Practice Address - Street 2:SUITE 2100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030
Practice Address - Country:US
Practice Address - Phone:713-798-4637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-21
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM6132208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8BZ370OtherBLUE CROSS BLUE SHIELD
TXP00968054OtherRR MEDICARE
TXP01063001OtherRAILROAD MEDICARE
TX186632904Medicaid
TX8BZ370OtherBLUE CROSS BLUE SHIELD
TXTXB151397Medicare PIN