Provider Demographics
NPI:1205196391
Name:ETHINGTON, BRADLEY A (DO)
Entity type:Individual
Prefix:
First Name:BRADLEY
Middle Name:A
Last Name:ETHINGTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2555 E 13TH ST STE 130
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-5135
Mailing Address - Country:US
Mailing Address - Phone:970-663-5437
Mailing Address - Fax:970-669-5762
Practice Address - Street 1:2555 E 13TH ST STE 130
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-5135
Practice Address - Country:US
Practice Address - Phone:970-663-5437
Practice Address - Fax:970-669-5762
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS94-07861208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics