Provider Demographics
NPI:1134138092
Name:WETTERER, HOWARD JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:JOHN
Last Name:WETTERER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 CALLE SAN GENARO
Mailing Address - Street 2:URB. SAGRADO CORAZON
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00926-4220
Mailing Address - Country:US
Mailing Address - Phone:787-801-3158
Mailing Address - Fax:787-801-3159
Practice Address - Street 1:AVE. GENERAL VALERO 313
Practice Address - Street 2:SUITE A
Practice Address - City:FAJARDO
Practice Address - State:PR
Practice Address - Zip Code:00738-4732
Practice Address - Country:US
Practice Address - Phone:787-801-3158
Practice Address - Fax:787-801-3159
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR14536208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR21118WEOtherTRIPLE SSS
PR21118WEOtherTRIPLE SSS
PR21118Medicare ID - Type Unspecified