Provider Demographics
NPI:1114966926
Name:ETHIER, DAVID BRIAN (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:BRIAN
Last Name:ETHIER
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 1:2801 SE 1ST AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-0478
Mailing Address - Country:US
Mailing Address - Phone:352-237-9298
Mailing Address - Fax:352-351-4193
Practice Address - Street 1:2801 SE 1ST AVE STE 302
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-0478
Practice Address - Country:US
Practice Address - Phone:352-237-9298
Practice Address - Fax:352-351-4193
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0071757207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251104500Medicaid
200031401OtherRAILROAD MC
FL32354OtherBC
FL251104500Medicaid
FL32354OtherBC
200031401OtherRAILROAD MC