Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | MD00021723 | WA |
NPI | 1043251697 |
---|---|
Provider Name | James B Erhardt |
First Address | Portland, OR 97208-3360 |
Second Address | Everett, WA 98201-4290 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/06/2006 |
Last Update Date | 18/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0195593 | LABOR AND INDUSTRY (01) | WA |
1301662 | (05) | WA |
B52649 | (02) | |
MD00021723 | STATE LICENSE NUMBER (01) | WA |
P00288625 | RAILROAD MEDICARE (01) | WA |