Healthcare Provider Details

I. General information

NPI: 1548408982
Provider Name (Legal Business Name): DAVID B. ETHIER MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2009
Last Update Date: 11/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11531 SE US HIGHWAY 301
BELLEVIEW FL
34420-4429
US

IV. Provider business mailing address

PO BOX 4118
BELLEVIEW FL
34421-4118
US

V. Phone/Fax

Practice location:
  • Phone: 352-307-7678
  • Fax: 352-307-7677
Mailing address:
  • Phone: 352-307-7678
  • Fax: 352-307-7677

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME0071757
License Number StateFL

VIII. Authorized Official

Name: MS. MARGOT E ETHIER
Title or Position: OFFICE MANAGER
Credential:
Phone: 352-307-7678