Provider Demographics
NPI: | 1669410486 |
---|---|
Name: | STIRLING, ERIC LEROY (MD) |
Entity type: | Individual |
Prefix: | DR |
First Name: | ERIC |
Middle Name: | LEROY |
Last Name: | STIRLING |
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: | 2065 THORNDYKE RD |
Mailing Address - Street 2: | |
Mailing Address - City: | PORT LUDLOW |
Mailing Address - State: | WA |
Mailing Address - Zip Code: | 98365-9531 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 360-531-4244 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 817 COMMERCIAL ST |
Practice Address - Street 2: | |
Practice Address - City: | LEAVENWORTH |
Practice Address - State: | WA |
Practice Address - Zip Code: | 98826-1316 |
Practice Address - Country: | US |
Practice Address - Phone: | 509-548-5815 |
Practice Address - Fax: | 509-584-2510 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2006-06-03 |
Last Update Date: | 2022-11-07 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
AK | AA2499 | 207P00000X, 207R00000X |
WA | MD60191712 | 207P00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
AK | 9717 | Medicaid | |
WA | 2086428 | Medicaid | |
WA | 452300 | Other | DEPARTMENT OF LABOR & INDUSTRIES |