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DR. ETHAN ROY ETNYRE MD

>> Family Medicine >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1225021777

Individual Registrant:
DR. ETHAN ROY ETNYRE MD
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

Contact information for business:
2050 S BLOSSER RD  SANTA MARIA, CA 93458-7310 US
Tel: 805-361-8028  Fax: 805-361-8097

Registration Information:
NPI: 1225021777
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y207Q00000XAllopathic & Osteopathic Physicians
Family Medicine
CAG073939

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
RAILROAD MEDICARE08014280601
BLUE SHIELD OF CALIFORNIA00G739390CA01
MEDICARE IDCB207800CA01
00G739390CA05




HEALTH CARE JOBS CA - Page 1



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