Individual
DR. JOHN KENDALL ETHRIDGE JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1000 E PRIMROSE ST STE 360, SPRINGFIELD, MO 65807
(417) 269-4037
(417) 269-6139
Mailing address
PO BOX 4046, SPRINGFIELD, MO 65808-4046
(417) 269-5712
(417) 269-7567
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
25614
OK
207VM0101X
Maternal & Fetal Medicine Physician
Primary
2018009510
MO
207VM0101X
Maternal & Fetal Medicine Physician
51003
TN
Other
Enumeration date
06/23/2007
Last updated
07/10/2018
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