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General NPI Number Information
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NPI Number | 1588717375
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Entity Type | Individual
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Provider Name | ERIC JOHN ROEDEL M.D.
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Gender | Male
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 05/01/2013
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Provider Practice Location Address
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Address Line | 3322 BROADWAY SUITE 200
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City | EVERETT
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State | WA
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Zip | 98201-4425
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Country | US
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Telephone | 425-249-4822
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Fax | 877-860-2284
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Provider Business Mailing Address
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Address Line | 200 OCEANGATE SUITE 100
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City | LONG BEACH
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State | CA
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Zip | 90802-4317
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Country | US
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Telephone | 562-499-6191
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Fax | 562-499-6171
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | MD00044505
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License Number State | WA
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