Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 6397 | MD |
N | 111NI0900X | Internist | 6397 | MD |
N | 207RC0200X | Critical Care Medicine | 63831 | MN |
Y | 207RP1001X | Pulmonary Disease | A136104 | CA |
N | 207RS0012X | Sleep Medicine | M-14570 | ID |
NPI | 1003110313 |
---|---|
Provider Name | Mr. Eric Ld Scholten |
First Address | Meridian, ID 83642-4881 |
Second Address | Meridian, ID 83642 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2010 |
Last Update Date | 29/07/2019 |