Individual
ETHAN E DUBRAVSKY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA11118
TX
363AM0700X
Medical Physician Assistant
Primary
PA11118
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
375669402
—
TX
Enumeration date
03/29/2017
Last updated
07/15/2022
Update your record
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