Provider Demographics
NPI:1689664724
Name:GARLAND, ERICH W (MD PA)
Entity Type:Individual
Prefix:DR
First Name:ERICH
Middle Name:W
Last Name:GARLAND
Suffix:
Gender:M
Credentials:MD PA
Other - Prefix:DR
Other - First Name:ERICH
Other - Middle Name:W
Other - Last Name:GARLAND
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD PA
Mailing Address - Street 1:3920 WASHINGTON PKWY
Mailing Address - Street 2:
Mailing Address - City:IDAHO FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83404-7596
Mailing Address - Country:US
Mailing Address - Phone:208-227-0158
Mailing Address - Fax:208-227-0159
Practice Address - Street 1:3920 WASHINGTON PKWY
Practice Address - Street 2:
Practice Address - City:IDAHO FALLS
Practice Address - State:ID
Practice Address - Zip Code:83404-7596
Practice Address - Country:US
Practice Address - Phone:208-227-0158
Practice Address - Fax:208-227-0159
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM59262084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002744200Medicaid
ID1376619OtherNEUROLOGY
E02188Medicare UPIN
ID1125200Medicare ID - Type Unspecified