Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Ethan Blythe, MD

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1205773405

Mr. Ethan Blythe, MD is a Student in an Organized Health Care Education/Training Program in Waco, Texas. Registered with an NPI since 2026.

In the registry since
2026
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1600 Providence Dr
Waco, TX 76707-2261
Phone: (254) 313-4200
Fax: (254) 313-4383
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X

Record details

NPI number1205773405
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedMay 4, 2026
Last updated in NPPESMay 4, 2026
Certification dateMay 4, 2026
Mailing address4807 Pin Oak Park Apt 10305, Houston, TX 77081-2178

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