Individual
DR. BRIAN ETHERIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1007 N POPE ST, SILVER CITY, NM 88061-5161
(575) 388-1511
(575) 313-8236
Mailing address
530 DE MOSS ST, LORDSBURG, NM 88045-2618
(575) 542-2307
(575) 313-8235
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MD2007-0195
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40906361
—
NM
Enumeration date
08/16/2006
Last updated
10/03/2017
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