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NPI Code Detail

MEDICARE: ALEXANDER ETHINGTON

MEDICARE: ALEXANDER ETHINGTON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training ProgramAL

General Provider Information

NPI Number : 1598698953
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEXANDER ETHINGTON
Provider Business Mailing Address
First Line : 10445 E IRWIN CIR
Second Line :
City : MESA
State : AZ
Zip : 85209-7723
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 7000 CHAD COLLEY BLVD
Second Line :
City : FORT SMITH
State : AR
Zip : 72916-6024
Country : US
Telephone Number : 479-308-2243
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2026
Last Update Date : 06/05/2026

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Directions to “ ALEXANDER ETHINGTON ” Practice Location

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