Provider Demographics
NPI:1548408982
Name:DAVID B. ETHIER MD, PA
Entity Type:Organization
Organization Name:DAVID B. ETHIER MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGOT
Authorized Official - Middle Name:E
Authorized Official - Last Name:ETHIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-307-7678
Mailing Address - Street 1:PO BOX 4118
Mailing Address - Street 2:
Mailing Address - City:BELLEVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:34421-4118
Mailing Address - Country:US
Mailing Address - Phone:352-307-7678
Mailing Address - Fax:352-307-7677
Practice Address - Street 1:11531 SE US HIGHWAY 301
Practice Address - Street 2:
Practice Address - City:BELLEVIEW
Practice Address - State:FL
Practice Address - Zip Code:34420-4429
Practice Address - Country:US
Practice Address - Phone:352-307-7678
Practice Address - Fax:352-307-7677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-22
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0071757207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL200031401OtherRAILROAD MEDICARE
FL251104500Medicaid
FL32354OtherBLUE CROSS
FL32354AMedicare PIN
FL32354OtherBLUE CROSS