Provider Demographics
NPI:1760434385
Name:ERDE, ALISON JOAN (MD)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:JOAN
Last Name:ERDE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 CENTENNIAL BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-4385
Mailing Address - Country:US
Mailing Address - Phone:541-726-1865
Mailing Address - Fax:541-726-2179
Practice Address - Street 1:1800 CENTENNIAL BLVD
Practice Address - Street 2:6
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-4385
Practice Address - Country:US
Practice Address - Phone:541-726-1865
Practice Address - Fax:541-726-2179
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD23479207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR063446Medicaid
OOOOWFBLYMedicare ID - Type Unspecified
OR063446Medicaid