Provider Demographics
NPI:1679885040
Name:KERI ERLAND MD - INTERNAL MEDICINE PC
Entity Type:Organization
Organization Name:KERI ERLAND MD - INTERNAL MEDICINE PC
Other - Org Name:KERI ERLAND, M.D. - INTERNAL MEDICINE, P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KERI
Authorized Official - Middle Name:
Authorized Official - Last Name:ERLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-231-8504
Mailing Address - Street 1:2298 NW KINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-3923
Mailing Address - Country:US
Mailing Address - Phone:541-230-1329
Mailing Address - Fax:541-230-1661
Practice Address - Street 1:2298 NW KINGS BLVD
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3923
Practice Address - Country:US
Practice Address - Phone:541-230-1329
Practice Address - Fax:541-230-1661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-13
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD29217207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORG24175Medicare UPIN