Provider Demographics
NPI:1508243692
Name:NEVATT, ERIK WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:WILLIAM
Last Name:NEVATT
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 1:2111 EXCHANGE ST
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:OR
Mailing Address - Zip Code:97103-3329
Mailing Address - Country:US
Mailing Address - Phone:503-325-4321
Mailing Address - Fax:
Practice Address - Street 1:1111 N ROOSEVELT DR STE 210
Practice Address - Street 2:
Practice Address - City:SEASIDE
Practice Address - State:OR
Practice Address - Zip Code:97138-4604
Practice Address - Country:US
Practice Address - Phone:503-738-3002
Practice Address - Fax:503-738-3005
Is Sole Proprietor?:No
Enumeration Date:2015-04-28
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD208781207Q00000X
MT65139207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine