Provider Demographics
NPI:1700221967
Name:STETSON, SONNY JOHN (MD, CSA)
Entity Type:Individual
Prefix:MR
First Name:SONNY
Middle Name:JOHN
Last Name:STETSON
Suffix:
Gender:M
Credentials:MD, CSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3524 OMEARA DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-5558
Mailing Address - Country:US
Mailing Address - Phone:713-909-9390
Mailing Address - Fax:
Practice Address - Street 1:3524 OMEARA DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-5558
Practice Address - Country:US
Practice Address - Phone:713-909-9390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-01
Last Update Date:2013-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12-181246ZS0410X, 246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist