MEDICARE: MR. ETHAN BRYCE TAUNTON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	390200000X	Student in an Organized Health Care Education/Training Program	S14684	AL

General Provider Information

NPI Number	:	1053252247
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ETHAN BRYCE TAUNTON

Provider Business Mailing Address
First Line	:	2316 WLAKER BUILDING
Second Line	:
City	:	AUBURN
State	:	AL
Zip	:	36849-0001
Country	:	US
Telephone Number	:	334-844-8348
Fax Number	:

Provider Business Practice Location Address
First Line	:	9085 ELKAHATCHEE RD
Second Line	:
City	:	ALEXANDER CITY
State	:	AL
Zip	:	35010-6093
Country	:	US
Telephone Number	:	256-537-0816
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/02/2026
Last Update Date	:	04/02/2026

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