Provider Demographics
NPI:1790876845
Name:HETHERLY, VRONI (MD)
Entity Type:Individual
Prefix:DR
First Name:VRONI
Middle Name:
Last Name:HETHERLY
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 1:84 NE LOOP 410
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-5802
Mailing Address - Country:US
Mailing Address - Phone:210-344-0506
Mailing Address - Fax:210-344-3512
Practice Address - Street 1:84 NE LOOP 410
Practice Address - Street 2:SUITE 140
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-5802
Practice Address - Country:US
Practice Address - Phone:210-344-0506
Practice Address - Fax:210-344-3512
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF55662084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81090VOtherBCBS