Provider Demographics
NPI:1639278575
Name:STRANDBERG, ERIC JOHN (MD)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:JOHN
Last Name:STRANDBERG
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 1:19521 22ND AVE NW
Mailing Address - Street 2:
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98177-2319
Mailing Address - Country:US
Mailing Address - Phone:206-542-7408
Mailing Address - Fax:
Practice Address - Street 1:1151 DENNY WAY
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-5326
Practice Address - Country:US
Practice Address - Phone:206-682-7418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA20900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA076229OtherL&I PROVIDER #
WAST9117OtherREGENCE RIDER #
WA076229OtherL&I PROVIDER #