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General NPI Number Information
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NPI Number | 1689806093
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Entity Type | Individual
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Provider Name | JAMES L ETHEREDGE M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/18/2009
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Last Update Date | 08/18/2009
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Provider Practice Location Address
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Address Line | 21 S CASEREA CT
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City | VERO BEACH
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State | FL
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Zip | 32963-1065
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Country | US
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Telephone | 772-231-4657
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Fax |
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Provider Business Mailing Address
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Address Line | 21 S CASEREA CT
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City | VERO BEACH
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State | FL
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Zip | 32963-1065
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Country | US
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Telephone | 772-231-4657
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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 | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MD.04187R
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License Number State | LA
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