Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 22197-020 | WI |
N | 207ND0101X | MOHS-Micrographic Surgeon | 22197-020 | WI |
N | 207ND0900X | Dermatopathologist | 22197-020 | WI |
N | 207NP0225X | Pediatric Dermatologist | 22197-020 | WI |
N | 207NS0135X | Procedural Dermatology | 22197-020 | WI |
NPI | 1770546053 |
---|---|
Provider Name | Dr. James Edward Ethington |
First Address | Greenfield, WI 53221-2626 |
Second Address | Greenfield, WI 53221-2626 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/04/2006 |
Last Update Date | 18/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30257400 | (05) | WI |
B52675 | (02) | WI |