Individual
STEPHEN WARD ETHEREDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
8080 BLUEBONNET BLVD STE 1000, BATON ROUGE, LA 70810-7827
(225) 924-2424
(225) 408-7980
Mailing address
8080 BLUEBONNET BLVD STE 1000, BATON ROUGE, LA 70810-7827
(225) 924-2424
(225) 408-7980
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
TRN 13458
FL
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
MD.205635
LA
Other
Enumeration date
04/29/2009
Last updated
08/26/2022
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