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Individual

DR. RICHARD THOMAS ETHRIDGE

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
1100 POUDRE RIVER DR UNIT A, FORT COLLINS, CO 80524-3557
(970) 484-6303
(704) 843-0369
Mailing address
151 SOUTHHALL LN STE 300, MAITLAND, FL 32751-7172
(970) 484-6303
(970) 484-3036

Taxonomy

Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
DR.0063642
CO
2086S0122X
Plastic and Reconstructive Surgery Physician
M5152
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
768289543
MYUTMB 768289543
Enumeration date
08/05/2007
Last updated
01/23/2020
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