Individual
WILLIAM BRUCE ETHRIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207RX0202X
Medical Oncology Physician
Primary
12956
AZ
2085R0001X
Radiation Oncology Physician
12956
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
249145
AHCCCS
AZ
Enumeration date
04/13/2006
Last updated
02/20/2008
Update your record
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