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DR. ETHAN ROY ETNYRE MD
>> Family Medicine >> Allopathic & Osteopathic PhysiciansRegistrant NPI Number: 1225021777
Individual Registrant:DR. ETHAN ROY ETNYRE MD
Gender: M
Not Sole Proprietor
Gender: M
Not Sole Proprietor
Location and contact information for practice:
2120 CIENAGA ST OCEANO, CA 93445-9016 US
Tel: 805-994-2100 Fax: 805-994-2197
Tel: 805-994-2100 Fax: 805-994-2197
Contact information for business:
2050 S BLOSSER RD SANTA MARIA, CA 93458-7310 US
Tel: 805-361-8028 Fax: 805-361-8097
Tel: 805-361-8028 Fax: 805-361-8097
Registration Information:
NPI: 1225021777
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| Y | 207Q00000X | Allopathic & Osteopathic Physicians Family Medicine | CA | G073939 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| RAILROAD MEDICARE | 080142806 | 01 | |
| BLUE SHIELD OF CALIFORNIA | 00G739390 | CA | 01 |
| MEDICARE ID | CB207800 | CA | 01 |
| 00G739390 | CA | 05 |
