MEDICARE: SHELLY ERFORD MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	A92213	CA

General Provider Information

NPI Number	:	1588790422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLY ERFORD MD

Provider Business Mailing Address
First Line	:	8049 NE 28TH ST
Second Line	:
City	:	MEDINA
State	:	WA
Zip	:	98039-1557
Country	:	US
Telephone Number	:	503-381-7439
Fax Number	:

Provider Business Practice Location Address
First Line	:	8049 NE 28TH ST
Second Line	:
City	:	MEDINA
State	:	WA
Zip	:	98039-1557
Country	:	US
Telephone Number	:	503-381-7439
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/26/2007
Last Update Date	:	07/20/2012

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