Individual
JACOB DANIEL ETHRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
1150 N LOOP 1604 W STE 150, SAN ANTONIO, TX 78248-4505
(281) 783-8162
(713) 439-7995
Mailing address
2925 BRIARPARK DR STE 575, HOUSTON, TX 77042-3776
(832) 626-2842
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA12348
TX
363A00000X
Physician Assistant
TEMPORARY
TX
Other
Enumeration date
09/28/2018
Last updated
06/29/2022
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