Provider Demographics
NPI:1134217102
Name:ERWIN, STANTON A (MD)
Entity type:Individual
Prefix:DR
First Name:STANTON
Middle Name:A
Last Name:ERWIN
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 1:316 MLK JR WY
Mailing Address - Street 2:STE 305
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405
Mailing Address - Country:US
Mailing Address - Phone:253-428-0205
Mailing Address - Fax:253-272-4765
Practice Address - Street 1:316 MLK JR WY
Practice Address - Street 2:STE 305
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405
Practice Address - Country:US
Practice Address - Phone:253-428-0205
Practice Address - Fax:253-272-4765
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2011-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00028363207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1064583Medicaid
WA001002083Medicare ID - Type Unspecified
WA1064583Medicaid