Provider Demographics
NPI:1225081656
Name:VETTER, THOMAS RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:RICHARD
Last Name:VETTER
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 1:1400 BARBARA JORDAN BLVD
Mailing Address - Street 2:DPRI SUITE 1.114
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-3092
Mailing Address - Country:US
Mailing Address - Phone:512-495-5089
Mailing Address - Fax:512-495-4944
Practice Address - Street 1:601 EAST 15TH STREET
Practice Address - Street 2:UNIVERSITY MEDICAL CENTER BRACKENRIDGE
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701
Practice Address - Country:US
Practice Address - Phone:512-324-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01058776207LP2900X, 207L00000X
TXQ9071207LP2900X, 207L00000X
AL28231207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051543360OtherBCBS
AL051595682OtherBCBS
AL009911331Medicaid
AL009911329Medicaid
AL051543358OtherBCBS
AL051543362OtherBCBS
IN200232170Medicaid
ALE22708OtherVIVA
AL009911327Medicaid
AL051543584OtherBCBS
AL106829Medicaid
ALP00653642OtherRAILROAD MEDICARE
AL051595682OtherBCBS
ALE22708OtherVIVA
ALP00653642OtherRAILROAD MEDICARE
INE22708Medicare UPIN