Provider Demographics
NPI:1518297845
Name:G.W.HETHERINGTON,M.D., P.A.
Entity Type:Organization
Organization Name:G.W.HETHERINGTON,M.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:HETHERINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:713-781-0474
Mailing Address - Street 1:2539 S GESSNER RD
Mailing Address - Street 2:STE 8
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77063-2028
Mailing Address - Country:US
Mailing Address - Phone:713-781-0474
Mailing Address - Fax:713-780-7511
Practice Address - Street 1:2539 S GESSNER RD
Practice Address - Street 2:STE 8
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-2028
Practice Address - Country:US
Practice Address - Phone:713-781-0474
Practice Address - Fax:713-780-7511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD1671174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB23472Medicare PIN