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Individual
DR. ETHAN ROY ETNYRE
Active
Individual
DR. ETHAN ROY ETNYRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
G073939
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G739390
BLUE SHIELD OF CALIFORNIA
CA
05
—
00G739390
—
CA
01
—
080142806
RAILROAD MEDICARE
—
01
—
CB207800
MEDICARE ID
CA
Enumeration date
08/30/2005
Last updated
11/07/2017
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