Provider Demographics
NPI:1770773954
Name:RICHARDSON, ERIN BROCK (MD)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:BROCK
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:MICHELLE
Other - Last Name:BROCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1401 NW 46TH ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-4635
Mailing Address - Country:US
Mailing Address - Phone:206-297-5360
Mailing Address - Fax:206-297-5364
Practice Address - Street 1:1401 NW 46TH ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-4635
Practice Address - Country:US
Practice Address - Phone:206-297-5360
Practice Address - Fax:206-297-5364
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD 60141618207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine