Healthcare Provider Details

I. General information

NPI: 1487618757
Provider Name (Legal Business Name): ERIK NELS BJARKE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 11/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 15TH AVE SE
PUYALLUP WA
98372-3754
US

IV. Provider business mailing address

7424 BRIDGEPORT WAY W SUITE 103
LAKEWOOD WA
98499-8120
US

V. Phone/Fax

Practice location:
  • Phone: 253-841-4353
  • Fax: 253-581-5698
Mailing address:
  • Phone: 253-841-4353
  • Fax: 253-581-5698

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD00030368
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG63506
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD17757
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: