Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD11719 | RI |
N | 111NI0900X | Internist | MD11719 | RI |
Y | 207RA0401X | Internist - Addiction Medicine | MD11719 | RI |
NPI | 1447221866 |
---|---|
Provider Name | Alex Etienne |
First Address | Providence, RI 02908-4728 |
Second Address | Providence, RI 02908-4728 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2006 |
Last Update Date | 13/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
29918 | BLUE CROSS OF RI (01) | RI |
412896 | BLUE CHIP OF RI (01) | RI |
7058051 | (05) | RI |
I44741 | (02) | RI |