Provider Demographics
NPI:1770665465
Name:FETCHICK, DIANNE ALAIA (MD)
Entity Type:Individual
Prefix:
First Name:DIANNE
Middle Name:ALAIA
Last Name:FETCHICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7863 CALLAGHAN RD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-2453
Mailing Address - Country:US
Mailing Address - Phone:866-693-4223
Mailing Address - Fax:888-237-7954
Practice Address - Street 1:13171 MISTY WILLOW DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-5635
Practice Address - Country:US
Practice Address - Phone:866-693-4223
Practice Address - Fax:888-237-7954
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2961207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX099837901Medicaid
TXTXB102648Medicare PIN
TX099837901Medicaid
TX8F1431Medicare PIN