Basic Information
Provider Information
NPI: 1184636086
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VOTH
FirstName: ERIC
MiddleName: A
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 901 SW GARFIELD AVE
Address2:  
City: TOPEKA
State: KS
PostalCode: 666061670
CountryCode: US
TelephoneNumber: 7853549591
FaxNumber: 7853680713
Practice Location
Address1: 901 SW GARFIELD AVE
Address2:  
City: TOPEKA
State: KS
PostalCode: 666061670
CountryCode: US
TelephoneNumber: 7853549591
FaxNumber: 7853680713
Other Information
ProviderEnumerationDate: 08/12/2006
LastUpdateDate: 06/12/2014
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207R00000X04-19709KSY Allopathic & Osteopathic PhysiciansInternal Medicine 

ID Information
IDTypeStateIssuerDescription
100178420A05KS MEDICAID
06704601KSMEDICARE PTANOTHER


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