Provider Demographics
NPI:1093789596
Name:ERICH, JONATHAN (MD)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:ERICH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:LEGACY SALMON CREEK HOSPITAL - FAMILY BIRTH CENTER
Mailing Address - Street 2:2211 N.E. 139TH STREET
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98686
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:LEGACY SALMON CREEK HOSPITAL - FAMILY BIRTH CENTER
Practice Address - Street 2:2211 N.E. 139TH STREET
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686
Practice Address - Country:US
Practice Address - Phone:360-487-4295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00036733207V00000X
OR16555207V00000X
CAG 51001207V00000X
MOMD R2K47207V00000X
IL003-036-073559-01207V00000X
WI43099-020207V00000X
MT8679207V00000X
GUM-895207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E34348Medicare UPIN