Provider Demographics
NPI:1982611893
Name:SPLETTER, ERIK DAVID (PA)
Entity Type:Individual
Prefix:
First Name:ERIK
Middle Name:DAVID
Last Name:SPLETTER
Suffix:
Gender:M
Credentials:PA
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 7779
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85011
Mailing Address - Country:US
Mailing Address - Phone:602-250-2133
Mailing Address - Fax:602-258-0123
Practice Address - Street 1:2034 E SOUTHERN
Practice Address - Street 2:4
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85282
Practice Address - Country:US
Practice Address - Phone:602-252-2133
Practice Address - Fax:602-258-0123
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2383363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ618704Medicaid
P44967Medicare UPIN
67924Medicare ID - Type Unspecified