Provider Demographics
NPI:1083612568
Name:KLEIN, ERIC JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:JOHN
Last Name:KLEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:110 DELPHI RD NW
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-1778
Mailing Address - Country:US
Mailing Address - Phone:360-352-2909
Mailing Address - Fax:360-352-2942
Practice Address - Street 1:110 DELPHI RD NW
Practice Address - Street 2:SUITE 101
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-1778
Practice Address - Country:US
Practice Address - Phone:360-352-2909
Practice Address - Fax:360-352-2942
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00028885207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1069160Medicaid
WA0151157OtherLABOR & INDUSTRIES
WAA43342Medicare UPIN
WA1069160Medicaid