Provider Demographics
NPI:1104836311
Name:DAHL, ERIK ALAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:ALAN
Last Name:DAHL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ERIK
Other - Middle Name:ALAN
Other - Last Name:DAHL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:307 BOATNER RD STE 114
Mailing Address - Street 2:
Mailing Address - City:EGLIN AFB
Mailing Address - State:FL
Mailing Address - Zip Code:32542-1302
Mailing Address - Country:US
Mailing Address - Phone:850-883-8600
Mailing Address - Fax:
Practice Address - Street 1:307 BOATNER RD STE 114
Practice Address - Street 2:
Practice Address - City:EGLIN AFB
Practice Address - State:FL
Practice Address - Zip Code:32542-1302
Practice Address - Country:US
Practice Address - Phone:850-883-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA39356208100000X
MDD0065698208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD80903900Medicaid
MDKG8589630901OtherBCBS TRADITIONAL MD
MDP00419968OtherRR MEDICARE
MDW2660015OtherBCBS REGIONAL MD
MD602LQ294Medicare PIN
MDKG8589630901OtherBCBS TRADITIONAL MD