Healthcare Provider Details

I. General information

NPI: 1285617654
Provider Name (Legal Business Name): DANIEL THOMAS ERCHUL CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 04/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 MAPLE STREET
ASHLAND OR
97520
US

IV. Provider business mailing address

1322 SEENA LANE
ASHLAND OR
97520-1322
US

V. Phone/Fax

Practice location:
  • Phone: 541-482-2441
  • Fax:
Mailing address:
  • Phone: 541-488-5115
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number200260021CRNA
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: