Provider Demographics
NPI:1801859285
Name:FETNER, CHRISTOPHER DRENNAN (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:DRENNAN
Last Name:FETNER
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 1:7777 FOREST LN
Mailing Address - Street 2:STE A315
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75230-2579
Mailing Address - Country:US
Mailing Address - Phone:972-566-7772
Mailing Address - Fax:972-566-4656
Practice Address - Street 1:7777 FOREST LN STE A315
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2579
Practice Address - Country:US
Practice Address - Phone:972-566-7772
Practice Address - Fax:972-566-7703
Is Sole Proprietor?:No
Enumeration Date:2006-04-07
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE0003208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110236004Medicaid
TX8M6738OtherBCBS
TXP00275099OtherRR MEDICARE
TX110236005Medicaid
TX110236004Medicaid
TX5639070001Medicare NSC
TX8G2590Medicare PIN
TX8M6738OtherBCBS