Provider Demographics
NPI:1003110313
Name:SCHOLTEN, ERIC LD (MD)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:LD
Last Name:SCHOLTEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2347 E GALA ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-4881
Mailing Address - Country:US
Mailing Address - Phone:208-323-3767
Mailing Address - Fax:208-323-3768
Practice Address - Street 1:2347 E GALA ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642
Practice Address - Country:US
Practice Address - Phone:208-323-3767
Practice Address - Fax:208-323-3768
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-29
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA136104207RP1001X
MD6397207R00000X
MN63831207RC0200X
IDM-14570207RS0012X
CODR.0071372207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine