Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | 5169 | WA |
NPI | 1023175627 |
---|---|
Provider Name | Dr. Raymond Alfred Erickson |
First Address | Spokane, WA 99208-6003 |
Second Address | Spokane, WA 99208-6003 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 02/01/2007 |
Last Update Date | 08/07/2007 |