Basic Information
| Provider Information | |||||||||
| NPI: | 1477502151 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HETZ | ||||||||
| FirstName: | STEPHEN | ||||||||
| MiddleName: | PAUL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | WBAMC, 5005 N. PIEDRAS STREET | ||||||||
| Address2: | ATTN: CREDENTIALS OFFICE, RM 10036 | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799205001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155692107 | ||||||||
| FaxNumber: | 9155691233 | ||||||||
| Practice Location | |||||||||
| Address1: | 5005 N. PIEDRAS STREET | ||||||||
| Address2: | ATTN: CREDENTIALS OFFICE, RM 10036 | ||||||||
| City: | EL PASO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 799205001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9155692107 | ||||||||
| FaxNumber: | 9155691233 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/09/2006 | ||||||||
| LastUpdateDate: | 08/29/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 28802 | AZ | Y | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.