Healthcare Provider Details

I. General information

NPI: 1477521318
Provider Name (Legal Business Name): ERIC M FLAKE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 JACKSON AVE
TACOMA WA
98431-6340
US

IV. Provider business mailing address

3801 KERN WAY
YAKIMA WA
98902-6340
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-2252
  • Fax: 253-968-3219
Mailing address:
  • Phone: 509-574-3220
  • Fax: 509-574-3211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD60567453
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code2080P0006X
TaxonomyDevelopmental - Behavioral Pediatrics Physician
License Number60567453
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: