Individual
ETHAN JOHN MYTINGER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1601 E 19TH AVE STE 5500, DENVER, CO 80218-1291
(303) 777-7112
(303) 722-7010
Mailing address
3333 S BANNOCK ST STE 350, ENGLEWOOD, CO 80110-2426
(303) 957-1310
(303) 761-4252
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6000000003748572
—
WI
05
—
9000181996
—
CO
Enumeration date
07/26/2019
Last updated
09/01/2022
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