MR. ETHAN BLYTHE MD
NPI 1205773405
Student in an Organized Health Care Education/Training Program in Waco, TX

Active since May 04, 2026
1600 PROVIDENCE DR, WACO, TX 76707(254) 313-4200(254) 313-4383 Get Directions Write a Review

NPPES record last updated: May 4, 2026. Verified against the NPPES registry weekly; last sync: August 02, 2026.

About Mr. Ethan Blythe Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. ETHAN BLYTHE MD (NPI 1205773405) is an individual student in an organized health care education/training program in Waco, Texas and active in the NPI registry since May 2026.

NPPES Registry Identity

NPI1205773405
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameMR. ETHAN BLYTHECredential: MD
Location Address1600 PROVIDENCE DRWaco, TX 76707-2261
Mailing Address4807 Pin Oak Park Apt 10305Houston, TX 77081-2178 · (254) 313-4200 · Fax (254) 313-4383
Fax(254) 313-4383
Sole ProprietorNo
Enumeration DateMay 4, 2026
NPPES CertifiedMay 4, 2026
NPI 1205773405 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Taxonomy Code390200000X
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.
1600 PROVIDENCE DR, Waco, TX 76707

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Family Medicine
1600 PROVIDENCE DR
WACO, TX 76707
Dentist
1600 PROVIDENCE DR
WACO, TX 76707
Family Medicine
1600 PROVIDENCE DR
WACO, TX 76707
Family Medicine
1600 PROVIDENCE DR
WACO, TX 76707
Family Medicine
1600 PROVIDENCE DR
WACO, TX 76707
Family Medicine
1600 PROVIDENCE DR
WACO, TX 76707
Social Worker
1600 PROVIDENCE DR
WACO, TX 76707
Family Medicine
1600 PROVIDENCE DR
WACO, TX 76707

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Ethan Blythe's NPI number?

The NPI number for Ethan Blythe is 1205773405. It was assigned to this individual provider in the NPPES registry on May 4, 2026.

Where is Ethan Blythe located?

Ethan Blythe practices at 1600 Providence Dr, Waco, TX 76707. The listed phone number is (254) 313-4200.

What is Ethan Blythe's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

When was this NPI record last updated?

The NPPES record for Ethan Blythe was last updated on May 4, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.