Individual
DR. ETHAN LICHTBLAU
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1531 THE ESPLANADE, CHICO, CA 95926-3310
(530) 332-7300
Mailing address
1531 THE ESPLANADE, CHICO, CA 95926-3310
(530) 332-7300
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
10692
ND
207X00000X
Orthopaedic Surgery Physician
Primary
G88013
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14386
—
ND
01
—
G88013
CA LICENSE
CA
Enumeration date
07/11/2007
Last updated
12/26/2007
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