Healthcare Provider Details

I. General information

NPI: 1134547045
Provider Name (Legal Business Name): CHRIS ETHRIDGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2014
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 N EAGLE CREEK DR
LEXINGTON KY
40509-1806
US

IV. Provider business mailing address

496 SOUTHLAND DR
LEXINGTON KY
40503-1827
US

V. Phone/Fax

Practice location:
  • Phone: 859-275-4878
  • Fax:
Mailing address:
  • Phone: 859-288-2425
  • Fax: 859-288-7510

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number55624
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number55624
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: