Individual
MR. MICHAEL C ETHEREDGE II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDMT
Contact information
Practice address
77 NEALY AVE, LANGLEY AFB, VA 23665-2040
(757) 764-6800
Mailing address
77 NEALY AVE, LANGLEY AFB, VA 23665-2040
Taxonomy
Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary
—
—
Other
Enumeration date
09/17/2019
Last updated
09/17/2019
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