Healthcare Provider Details

I. General information

NPI: 1508568742
Provider Name (Legal Business Name): ERIC DEL HISLOP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2023
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W FAIRVIEW ST
COLFAX WA
99111-9552
US

IV. Provider business mailing address

1200 W FAIRVIEW ST
COLFAX WA
99111-9552
US

V. Phone/Fax

Practice location:
  • Phone: 509-397-5704
  • Fax: 509-397-4713
Mailing address:
  • Phone: 509-397-5704
  • Fax: 509-397-4713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.MD.70125843
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: