Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | MD00015424 | WA |
NPI | 1831150879 |
---|---|
Provider Name | Dr. Eric Walter Luria |
First Address | Gig Harbor, WA 98335-7313 |
Second Address | Gig Harbor, WA 98335-7313 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0015413 | L&I NUMBER (01) | WA |
1429406 | (05) | WA |
A08505 | (02) | WA |
AL7253141 | DEA NUMBER (01) | WA |
MD00015424 | STATE LICENSE (01) | WA |