| Doctor Name: | MR. RODNEY STACY ETHERIDGE |
| NPI Number: | 1073635991 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | RVT, RDMS |
| License Number: | 30038 |
| Business Practice Address: | 17450 Main St Suite B Hesperia, CA - 923456298 |
| Business Phone Number: | 7606469902 |
| Business Fax Number: | 7606469902 |
| Mailing Address: | 17450 Main St, Suite B HESPERIA |
| State: | CA |
| Postal Code: | 923456298 |
| Phone Number: | 7606469902 |
| Fax Number: | 7606469902 |
| NPI Enumeration Date: | 04/03/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 2085U0001X |
| License Number: | 30038 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | Radiology |
| Taxonomy Specialization: | Diagnostic Ultrasound |
| Taxonomy Definition: | A Radiology doctor of Osteopathy that specializes in Diagnostic Ultrasound. |