Provider Demographics
NPI:1942225875
Name:LAUER, ERIC CLYDE (PAC)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:CLYDE
Last Name:LAUER
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 POINT FOSDICK DR STE 202
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-1706
Mailing Address - Country:US
Mailing Address - Phone:253-858-9192
Mailing Address - Fax:253-426-6344
Practice Address - Street 1:4700 POINT FOSDICK DR STE 202
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1706
Practice Address - Country:US
Practice Address - Phone:253-858-9192
Practice Address - Fax:253-426-6344
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA3006363AM0700X
WAAP60732647363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1022720Medicaid
WAAB17482Medicare ID - Type Unspecified