Provider Demographics
NPI:1760645444
Name:LEA, ETHAN SCOTT (MD)
Entity Type:Individual
Prefix:DR
First Name:ETHAN
Middle Name:SCOTT
Last Name:LEA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:6620 COYLE AVE
Mailing Address - Street 2:SUITE 212
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-6333
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6620 COYLE AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-6333
Practice Address - Country:US
Practice Address - Phone:916-536-9455
Practice Address - Fax:916-536-9424
Is Sole Proprietor?:No
Enumeration Date:2008-07-03
Last Update Date:2014-11-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA126669207XX0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0801XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Trauma