Provider Demographics
NPI:1679614747
Name:ERWIN, ROBERT LEE JR (CRNA)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:LEE
Last Name:ERWIN
Suffix:JR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E COLLEGE DR
Mailing Address - Street 2:
Mailing Address - City:COLBY
Mailing Address - State:KS
Mailing Address - Zip Code:67701-3702
Mailing Address - Country:US
Mailing Address - Phone:785-462-7511
Mailing Address - Fax:785-460-9320
Practice Address - Street 1:100 E COLLEGE DR
Practice Address - Street 2:
Practice Address - City:COLBY
Practice Address - State:KS
Practice Address - Zip Code:67701-3702
Practice Address - Country:US
Practice Address - Phone:785-462-7511
Practice Address - Fax:785-460-9320
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2016-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS43-55737367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS43-557377OtherSTATE LICENSE
ORR166172Medicare PIN
OR1487696985OtherCURRY GENERAL HOSPITAL NPI
OR139890Medicare PIN
OR93-0937095OtherCURRY HEALTH DISTRICT TAX I.D.