Individual
DR. JONATHAN ETHERIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
29 NW 1ST LN, LAMAR, MO 64759-8105
(417) 681-5100
Mailing address
29 NW 1ST LN, LAMAR, MO 64759-8105
(417) 681-5100
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
2012003246
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1063674661
—
MO
01
—
440552485
TRICARE
MO
01
—
P01119720
RR MCR
MO
Enumeration date
06/26/2008
Last updated
04/30/2026
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