Individual
MARK ETHERIDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
2451 FILLINGIM ST, MOBILE, AL 36617-2238
(251) 471-7035
(251) 471-7042
Mailing address
5680 SHELBY LN, WILMER, AL 36587-6800
(251) 645-2529
(251) 645-2529
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
1-080454
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
051552967
—
AL
Enumeration date
09/21/2005
Last updated
05/01/2017
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