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General NPI Number Information
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NPI Number | 1508156696
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Entity Type | Individual
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Provider Name | ETHAN BRANDON RUTLEDGE D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/11/2011
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 110 DUNHILL PL NW
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City | CLEVELAND
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State | TN
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Zip | 37311
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Country | US
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Telephone | 423-476-2212
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Fax |
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Provider Business Mailing Address
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Address Line | 110 DUNHILL PL NW
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City | CLEVELAND
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State | TN
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Zip | 37311-3866
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Country | US
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Telephone | 423-476-2212
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 34.011041
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 3169
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License Number State | TN
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