Provider Demographics
NPI:1831150879
Name:LURIA, ERIC WALTER (MD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:WALTER
Last Name:LURIA
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 1:4402 HUNT ST NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-7313
Mailing Address - Country:US
Mailing Address - Phone:253-851-6181
Mailing Address - Fax:253-851-6191
Practice Address - Street 1:4402 HUNT ST NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-7313
Practice Address - Country:US
Practice Address - Phone:253-851-6181
Practice Address - Fax:253-851-6191
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00015424204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1429406Medicaid
WA0015413OtherL&I NUMBER
WAMD00015424OtherSTATE LICENSE
WAMD00015424OtherSTATE LICENSE
WAAL7253141OtherDEA NUMBER