Provider Demographics
NPI:1750580775
Name:DIDIER, ERICA (MD)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:DIDIER
Suffix:
Gender:F
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:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:WHITE SALMON
Mailing Address - State:WA
Mailing Address - Zip Code:98672-0099
Mailing Address - Country:US
Mailing Address - Phone:509-493-1101
Mailing Address - Fax:541-308-8396
Practice Address - Street 1:211 SKYLINE DR
Practice Address - Street 2:PO BOX 99
Practice Address - City:WHITE SALMON
Practice Address - State:WA
Practice Address - Zip Code:98672
Practice Address - Country:US
Practice Address - Phone:509-637-2810
Practice Address - Fax:509-493-1368
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA96759207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500614175Medicaid