Provider Demographics
NPI:1023013109
Name:KLEIN, ERIC W (MD,MPH, TM)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:W
Last Name:KLEIN
Suffix:
Gender:M
Credentials:MD,MPH, TM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2855 E MAGIC VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-6245
Mailing Address - Country:US
Mailing Address - Phone:208-639-4900
Mailing Address - Fax:208-639-4901
Practice Address - Street 1:2855 E MAGIC VIEW DR
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-6245
Practice Address - Country:US
Practice Address - Phone:208-639-4900
Practice Address - Fax:208-639-4901
Is Sole Proprietor?:No
Enumeration Date:2005-06-16
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM8502174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID806360400Medicaid
IDB5599OtherBLUE CROSS MERIDIAN
IDP00250188OtherRAILROAD MEDICARE
ID76535OtherBLUE CROSS NAMPA
ID000010152028OtherBLUE SHIELD NAMPA
ID000010157178OtherBLUE SHIELD MERIDIAN
ID1105941Medicare ID - Type UnspecifiedMEDICARE
ID000010152028OtherBLUE SHIELD NAMPA