Individual
ETHAN NERE BEAUDETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O
Contact information
Practice address
738 LIBRARY ROAD, #1, ROCHESTER, NY 14627-0617
(585) 275-2662
(585) 276-0149
Mailing address
738 LIBRARY ROAD, PO BOX 270617, ROCHESTER, NY 14627-0617
(585) 275-2662
(585) 276-0149
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
290946
NY
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
290946
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/11/2014
Last updated
06/30/2023
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