# ETHAN MILTON CRUVANT

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1740287192
- **Gender:** Man
- **Credential:** MD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | 5854 | NV | Yes |

## Other

- **Enumeration date:** 06/30/2005
- **Last updated:** 06/14/2011

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 002019008 | — | NV |
| 01 | — | 110227382 | RAILROAD MEDICARE | — |
| 01 | — | 880344806A002 | TRIWEST | — |