| Doctor Name: | DR. ETHAN ANGLEMYER |
| NPI Number: | 1770996068 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.O. |
| License Number: | UO3877 |
| Business Practice Address: | 7201 N University Dr Tamarac, FL - 333212913 |
| Business Phone Number: | 9547246540 |
| Business Fax Number: | |
| Mailing Address: | 7201 N University Dr, TAMARAC |
| State: | FL |
| Postal Code: | 333212913 |
| Phone Number: | 9547246540 |
| Fax Number: | |
| NPI Enumeration Date: | 06/04/2014 |
| NPI Last Update Date: | 06/04/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 390200000X |
| License Number: | UO3877 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Student, Health Care |
| Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
| Taxonomy Specialization: | |
| Taxonomy 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. |