Individual
JOHN BRUCE ETHERIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1320 RIBAUT RD, PORT ROYAL, SC 29935-1118
(843) 986-0900
Mailing address
721 OKATIE HWY, OKATIE, SC 29909-3963
(843) 987-7400
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
19936
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
199369
—
SC
Enumeration date
10/03/2006
Last updated
06/16/2026
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