Individual
TIMOTHY ETHRIDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5955 ZEAMER AVE, ANCHORAGE, AK 99506-3702
(907) 580-1711
(111) 111-1111
Mailing address
5955 ZEAMER AVE, ANCHORAGE, AK 99506-3702
(907) 580-1711
(111) 111-1111
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
363AM0700X
Medical Physician Assistant
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/20/2019
Last updated
07/09/2024
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