Provider Demographics
NPI:1396794350
Name:LINDSTROM, ERIC J (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:J
Last Name:LINDSTROM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2925
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98907-2925
Mailing Address - Country:US
Mailing Address - Phone:509-248-6633
Mailing Address - Fax:509-248-0178
Practice Address - Street 1:315 HOLTON AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-3254
Practice Address - Country:US
Practice Address - Phone:509-248-6633
Practice Address - Fax:509-248-0178
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WABL94070012085R0202X
WAMD 605512812085R0202X
GA0575332085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA748617841Medicaid
WA2044744Medicaid
GA30BDMVRMedicare Oscar/Certification
WA2044744Medicaid
GA748617841Medicaid
GAGRP1205Medicare PIN