Healthcare Provider Details

I. General information

NPI: 1881693919
Provider Name (Legal Business Name): MARK J ERWIN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 03/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5633 N LIDGERWOOD ST
SPOKANE WA
99208-1224
US

IV. Provider business mailing address

9631 N NEVADA ST STE 210
SPOKANE WA
99218-1197
US

V. Phone/Fax

Practice location:
  • Phone: 509-252-6336
  • Fax: 509-252-6337
Mailing address:
  • Phone: 509-319-2431
  • Fax: 877-568-2402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10004364
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: