Individual provider · Type 1 NPI

Ethan Blythe, MD

Student in an Organized Health Care Education/Training Program · Waco, TX

NPI number 1205773405 Active

Practice location

1600 Providence Dr
Waco, TX 76707-2261

Call (254) 313-4200 Map

Fax (254) 313-4383

Mailing address

4807 Pin Oak Park Apt 10305
Houston, TX 77081-2178

Specialties and licenses

TaxonomyCodeLicense
Student in an Organized Health Care Education/Training Program Primary 390200000XNone listed

Student in an Organized Health Care Education/Training Program: 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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About NPI 1205773405

Ethan Blythe, MD's National Provider Identifier is 1205773405, issued on May 4, 2026. The primary taxonomy on file is Student in an Organized Health Care Education/Training Program (390200000X), and the practice location is in Waco, TX. The record was last updated on May 4, 2026.