Provider Demographics
NPI:1225274038
Name:SHIBLEY, ERIC RYAN (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:RYAN
Last Name:SHIBLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:CHOUDHURY
Other - Middle Name:SHIBLEE
Other - Last Name:NOMANY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:4700 36TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98126-2716
Mailing Address - Country:US
Mailing Address - Phone:206-938-4291
Mailing Address - Fax:206-260-1412
Practice Address - Street 1:4700 36TH AVE SW
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98126-2716
Practice Address - Country:US
Practice Address - Phone:206-938-4291
Practice Address - Fax:206-938-4483
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-29
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60108064207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine