Provider Demographics
NPI:1811131113
Name:SEMLER, ERIC (IDMT)
Entity type:Individual
Prefix:MR
First Name:ERIC
Middle Name:
Last Name:SEMLER
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 JABARRAH AVE
Mailing Address - Street 2:SEYMOUR JOHNSON AIR FORCE BASE
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27531-2310
Mailing Address - Country:US
Mailing Address - Phone:919-722-1293
Mailing Address - Fax:919-722-1956
Practice Address - Street 1:1050 JABARRAH AVE
Practice Address - Street 2:SEYMOUR JOHNSON AIR FORCE BASE
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27531-2310
Practice Address - Country:US
Practice Address - Phone:919-722-1293
Practice Address - Fax:919-722-1956
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1101XAmbulatory Health Care FacilitiesClinic/CenterMilitary and U.S. Coast Guard Ambulatory Procedure