Individual
ETHAN JOHN BUDSOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2301 ERWIN RD, DURHAM, NC 27705-4699
(919) 684-8111
Mailing address
1105 PALE MOSS DR, DURHAM, NC 27704-3278
(443) 813-2640
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
R238820
MD
Other
Enumeration date
08/17/2023
Last updated
08/17/2023
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