Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | M-10358 | ID |
N | 207Q00000X | Family Doctor | MD00045927 | WA |
Y | 207QS0010X | Family Doctor - Sports Medicine | MD00045927 | WA |
NPI | 1295732030 |
---|---|
Provider Name | Eric Robert Anderson |
First Address | Spokane, WA 99202-1334 |
Second Address | Spokane, WA 99202-1334 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2005 |
Last Update Date | 13/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
807782300 | (05) | ID |
8451221 | (05) | WA |
I59929 | (02) |