Provider Demographics
NPI:1912390394
Name:SARTOR, ERICH DAVID (BOCO)
Entity Type:Individual
Prefix:MR
First Name:ERICH
Middle Name:DAVID
Last Name:SARTOR
Suffix:
Gender:M
Credentials:BOCO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5102 WHITEFISH DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65203-6490
Mailing Address - Country:US
Mailing Address - Phone:573-673-6859
Mailing Address - Fax:
Practice Address - Street 1:2601 MAGUIRE BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8253
Practice Address - Country:US
Practice Address - Phone:573-234-2005
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-10
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
C50250174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
C50250OtherBOARD OF CERTIFICATION AND ACCREDITATION FOR ORTHOTIC AND PROSTHETICS