Provider Demographics
NPI:1922059146
Name:ERLAND, KERI (MD)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:
Last Name:ERLAND
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 1:3667 N LOCUST GROVE RD
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-5924
Mailing Address - Country:US
Mailing Address - Phone:208-939-9090
Mailing Address - Fax:208-939-9911
Practice Address - Street 1:3667 N LOCUST GROVE RD
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83646-5924
Practice Address - Country:US
Practice Address - Phone:208-939-9090
Practice Address - Fax:208-939-9911
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM6886207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G24175Medicare UPIN