Provider Demographics
NPI:1417931908
Name:ERMER, BRIAN D (PAC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:D
Last Name:ERMER
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1460
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:SD
Mailing Address - Zip Code:57402-1460
Mailing Address - Country:US
Mailing Address - Phone:605-226-2663
Mailing Address - Fax:605-226-0095
Practice Address - Street 1:701 8TH AVE NW
Practice Address - Street 2:SUITE A
Practice Address - City:ABERDEEN
Practice Address - State:SD
Practice Address - Zip Code:57401-1803
Practice Address - Country:US
Practice Address - Phone:605-226-2663
Practice Address - Fax:605-226-0095
Is Sole Proprietor?:No
Enumeration Date:2005-11-30
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0597363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6828080Medicaid
SD100485Medicare PIN
SD1108470001Medicare NSC
SDP00291758Medicare PIN
ND712021Medicare PIN
SD6828080Medicaid