Individual
ETHAN A PRAIRIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4005 HIGH RESORT BLVD SE, RIO RANCHO, NM 87124-5906
(505) 462-6000
Mailing address
4005 HIGH RESORT BLVD SE, RIO RANCHO, NM 87124-5906
(505) 462-6000
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD2023-0538
NM
Other
Enumeration date
04/20/2020
Last updated
12/29/2023
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