Provider Demographics
NPI:1831944537
Name:LI, ETHAN CONNER
Entity type:Individual
Prefix:
First Name:ETHAN
Middle Name:CONNER
Last Name:LI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11210 DESERT ORANGETIP DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-0388
Mailing Address - Country:US
Mailing Address - Phone:951-207-3332
Mailing Address - Fax:
Practice Address - Street 1:12600 MCCALLEN PASS APT 6314
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-5469
Practice Address - Country:US
Practice Address - Phone:951-207-3332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant