Healthcare Provider Details

I. General information

NPI: 1730154493
Provider Name (Legal Business Name): ANNE-MARIE ETHIER HAIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANNE-MARIE MCDONALD ETHIER

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 12/09/2021
Certification Date: 12/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 W LANCASTER AVE STE 205
FORT WORTH TX
76102-3490
US

IV. Provider business mailing address

PO BOX 733784
DALLAS TX
75373-3784
US

V. Phone/Fax

Practice location:
  • Phone: 817-336-8611
  • Fax: 817-390-2981
Mailing address:
  • Phone: 682-885-1855
  • Fax: 682-885-1396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberP4176
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License NumberP4176
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: