Healthcare Provider Details

I. General information

NPI: 1992277859
Provider Name (Legal Business Name): ERIK FRANK BJODSTRUP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 12/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2970 SW AVALON WAY
SEATTLE WA
98126-2551
US

IV. Provider business mailing address

2970 SW AVALON WAY
SEATTLE WA
98126-2551
US

V. Phone/Fax

Practice location:
  • Phone: 206-883-2051
  • Fax:
Mailing address:
  • Phone: 206-883-2051
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberCG60152611
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: