Healthcare Provider Details

I. General information

NPI: 1437191996
Provider Name (Legal Business Name): VICTOR M ERLICH PH.D., M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 NE 87TH AVE STE 460
VANCOUVER WA
98664-1965
US

IV. Provider business mailing address

1536 N 115TH ST STE 330
SEATTLE WA
98133-8425
US

V. Phone/Fax

Practice location:
  • Phone: 360-514-7771
  • Fax: 360-514-7769
Mailing address:
  • Phone: 206-365-0111
  • Fax: 206-365-2980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number370
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberMD00026536
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: