Individual provider Active NPI

Russell Earl Fetzer, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • San Antonio, TX
National Provider Identifier
1497199343
Registry record updated May 30, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
R0392 Issued in TX
Practice address
7700 Floyd Curl Dr
San Antonio, TX 78229-3902
Phone
(210) 575-9163
NPI assigned
Apr 22, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 30, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cytopathology Physician 207ZC0500X R0392 TX
Anatomic Pathology & Clinical Pathology Physician 207ZP0102X R0392 TX Primary

Addresses

Primary practice location

7700 Floyd Curl Dr
San Antonio, TX 78229-3902

Mailing address

PO Box 681149
San Antonio, TX 78268-1149
Phone (210) 558-6288

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220613000921 TX Practitioner - Pathology 9335527894 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pathology
Education
University of Texas Southwestern Medical School at Dallas, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
South Texas Pathology Associates LLPGroup PAC ID 6406851054, 25 clinicians

Practice addresses (Care Compare)

7700 Floyd Curl Dr
San Antonio, TX 78229-3902
Phone (210) 558-6288

Hospital & facility affiliations

  • Methodist Hospital Hospital, San Antonio, TX, CCN 450388
  • Methodist Hospital Stone Oak Hospital, San Antonio, TX, CCN 670055

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
R0392TXMDCytopathology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
South Texas Pathology Associates LLP Anatomic Pathology & Clinical Pathology CurrentSince Jul 1, 2022 Accepting new patients

Locations

1139 E Sonterra Blvd
San Antonio, TX 78258
Phone (210) 638-2000

7700 Floyd Curl Dr
San Antonio, TX 78229
Phone (210) 575-5564

4085 De Zavala Rd
Shavano Park, TX 78249

4085 De Zavala Rd
Ste 200
Shavano Park, TX 78249
Phone 2105586288123

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1366588800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717027200000",
    "number": "1497199343",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 681149",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782681149",
            "telephone_number": "210-558-6288",
            "fax_number": "210-558-6289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7700 FLOYD CURL DR",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782293902",
            "telephone_number": "210-575-9163"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FETZER",
        "first_name": "RUSSELL",
        "middle_name": "EARL",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-04-22",
        "last_updated": "2024-05-30",
        "certification_date": "2024-05-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207ZC0500X",
            "taxonomy_group": "",
            "desc": "Pathology, Cytopathology",
            "state": "TX",
            "license": "R0392",
            "primary": false
        },
        {
            "code": "207ZP0102X",
            "taxonomy_group": "",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "TX",
            "license": "R0392",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

Verify at the official NPI Registry.