Mr Ethan Edward Smith, PA-C is a
Physician Assistant based in Spooner, Wisconsin. Mr Ethan Edward Smith is licensed to practice in Wisconsin (license number 8040) and his current practice location is
1180 Chandler Dr, Spooner, Wisconsin. He can be reached at his office (for appointments etc.) via phone at
(715) 635-2151.
NPI number for Mr Ethan Edward Smith is 1073215984 and his current mailing address is 400 E 3rd St, Duluth, Minnesota. He
does not participate in medicare program and thus does not accept medicare assignments. His NPI Number is 1073215984.
Provider's Profile
| Full Name | Mr Ethan Edward Smith |
|---|
| Gender | Male |
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| Speciality | Physician Assistant |
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| Location | 1180 Chandler Dr, Spooner, Wisconsin |
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| Accepts Medicare Assignments | Does not participate in Medicare Program. He may not accept medicare assignment. |
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NPI Data:
- NPI Number: 1073215984
- Provider Enumeration Date: 03/22/2023
- Last Update Date: 09/11/2024
Medical Identifiers
Medical identifiers for Mr Ethan Edward Smith such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1073215984 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 363A00000X | Physician Assistant | 8040 (Wisconsin) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Mr Ethan Edward Smith is
NOT enrolled with medicare and thus cannot prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Mr Ethan Edward Smith, PA-C
400 E 3rd St,
Duluth, MN 55805-1951
Ph: (218) 786-8364 | Mr Ethan Edward Smith, PA-C
1180 Chandler Dr,
Spooner, WI 54801-2204
Ph: (715) 635-2151 |
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