Individual
JASON ETHEREDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, PHD
Contact information
Practice address
1010 N KANSAS ST, WICHITA, KS 67214-3124
(316) 268-5000
Mailing address
1010 N KANSAS ST, WICHITA, KS 67214-3124
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
046821
KS
Other
Enumeration date
06/22/2007
Last updated
03/18/2008
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