Provider Demographics
NPI:1548828577
Name:PERCY, ETHAN THOMAS (DO)
Entity type:Individual
Prefix:
First Name:ETHAN
Middle Name:THOMAS
Last Name:PERCY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 MAIN ST STE 204
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-1939
Mailing Address - Country:US
Mailing Address - Phone:207-300-4027
Mailing Address - Fax:207-300-4028
Practice Address - Street 1:194 MAIN ST STE 204
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-1939
Practice Address - Country:US
Practice Address - Phone:207-300-4027
Practice Address - Fax:207-300-4028
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-04
Last Update Date:2024-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDO3350207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine