Individual
MR. ETHAN TAYLOR BROADHEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
3600 BROADWAY, OAKLAND, CA 94611-5730
(510) 752-1000
Mailing address
8103 BAGLEY RD, DORA, AL 35062-1931
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
1-183115
AL
Other
Enumeration date
04/17/2026
Last updated
04/17/2026
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