| Doctor Name: | JOHN A. ICETON |
| NPI Number: | 1770583858 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | H6857 |
| Business Practice Address: | 2927 Park Plaza Ln Port Arthur, TX - 776425516 |
| Business Phone Number: | 4099835178 |
| Business Fax Number: | 4099836078 |
| Mailing Address: | 2927 Park Plaza Ln, PORT ARTHUR |
| State: | TX |
| Postal Code: | 776425516 |
| Phone Number: | 4099835178 |
| Fax Number: | 4099836078 |
| NPI Enumeration Date: | 07/29/2005 |
| NPI Last Update Date: | 02/13/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 174400000X |
| License Number: | H6857 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Other Service Providers |
| Taxonomy Classification: | Specialist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |