Provider Demographics
NPI:1669474284
Name:VANMETRE, JOHN EDWARD (MD)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:EDWARD
Last Name:VANMETRE
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 1:4504 N. LAURENT ST.
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-2743
Mailing Address - Country:US
Mailing Address - Phone:361-573-9999
Mailing Address - Fax:361-573-9973
Practice Address - Street 1:4504 N. LAURENT ST.
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-2743
Practice Address - Country:US
Practice Address - Phone:361-573-9999
Practice Address - Fax:361-573-9973
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE19417174400000X
TXP1604207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE01597OtherBLUE CROSS BLUE SHIELD NE
NEE78813Medicare UPIN
NE01597OtherBLUE CROSS BLUE SHIELD NE
TXB158433Medicare UPIN