Provider Demographics
NPI:1114952090
Name:CARY, ETHAN ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:ETHAN
Middle Name:ROBERT
Last Name:CARY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4277
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80155-4277
Mailing Address - Country:US
Mailing Address - Phone:303-220-5707
Mailing Address - Fax:
Practice Address - Street 1:6161 S SYRACUSE WAY
Practice Address - Street 2:310
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-4707
Practice Address - Country:US
Practice Address - Phone:303-220-5707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO29496207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01294966Medicaid
CO01294966Medicaid
COE25454Medicare UPIN