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Ethan Massingill, DO
Student in an Organized Health Care Education/Training Program in Tyler, Texas
NPI 1619665478

Ethan Massingill is a Student in an Organized Health Care Education/Training Program based in Tyler, TX. Ethan Massingill practices in Tyler, TX and has the professional credentials of DO. The NPI Number for Ethan Massingill is 1619665478 and holds a License No. BP10085240 (Texas).

The current practice location address for Ethan Massingill is 11937 Us Highway 271, Tyler, TX and can be reached out via phone at 903-877-7200.

Location: 11937 Us Highway 271, Tyler, TX, 75708-3154
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1619665478
Provider Name
Ethan Massingill
Credential
DO
Provider Entity Type
Individual
Gender
Male
Address
11937 Us Highway 271, Tyler, TX, 75708-3154
Phone Number
903-877-7200
Fax Number
Provider Enumeration Date
04/28/2023
Last Update Date
03/10/2024
institution
Provider Business Practice Location Address Details
Address
11937 Us Highway 271
City
Tyler
State
Texas
Zip
75708-3154
Phone Number
903-877-7200
Fax Number
person
Provider Business Mailing Address Details
Address
11937 Us Highway 271
City
Tyler
State
Texas
Zip
75708-3154
Phone Number
903-877-7200
Fax Number
person
Provider's Taxonomy Details 1
Type
Student, Health Care
Classification
Student in an Organized Health Care Education/Training Program
Speciality
-
Taxonomy
390200000X
License No.
BP10085240 (Texas)
Definition
An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.
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