Healthcare Provider Details

I. General information

NPI: 1437139045
Provider Name (Legal Business Name): ROBERT EUGENE EHRLICH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 LINCOLN ST SUITE 100
KELSO WA
98626-1057
US

IV. Provider business mailing address

700 LINCOLN ST SUITE 100
KELSO WA
98626-1057
US

V. Phone/Fax

Practice location:
  • Phone: 360-425-5131
  • Fax: 360-425-5509
Mailing address:
  • Phone: 360-425-5131
  • Fax: 360-425-5509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD00015106
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: