Provider Demographics
NPI:1083955199
Name:EHRLICH, ALLISON
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:
Last Name:EHRLICH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MYRTLE POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97458-1066
Mailing Address - Country:US
Mailing Address - Phone:541-572-2111
Mailing Address - Fax:541-572-5743
Practice Address - Street 1:324 4TH ST
Practice Address - Street 2:
Practice Address - City:MYRTLE POINT
Practice Address - State:OR
Practice Address - Zip Code:97458-1066
Practice Address - Country:US
Practice Address - Phone:541-572-2111
Practice Address - Fax:541-572-5743
Is Sole Proprietor?:No
Enumeration Date:2013-03-14
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ORPA169624363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1407812365OtherGROUP NPI NORTH BEND MEDICAL CENTER
OR161133OtherGROUP DMAP NORTH BEND MEDICAL CENTER
OR500676697Medicaid
ORR0000WFBTVOtherGROUP MEDICARE NORTH BEND MEDICAL CENTER
ORP01411693OtherRAILROAD MEDICARE
ORR0000WFBTVOtherGROUP MEDICARE NORTH BEND MEDICAL CENTER
ORP01411693OtherRAILROAD MEDICARE