Basic Information
| Provider Information | |||||||||
| NPI: | 1750580775 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | DIDIER | ||||||||
| FirstName: | ERICA | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 99 | ||||||||
| Address2: | |||||||||
| City: | WHITE SALMON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986720099 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5094931101 | ||||||||
| FaxNumber: | 5413088396 | ||||||||
| Practice Location | |||||||||
| Address1: | 211 SKYLINE DR | ||||||||
| Address2: | PO BOX 99 | ||||||||
| City: | WHITE SALMON | ||||||||
| State: | WA | ||||||||
| PostalCode: | 98672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5096372810 | ||||||||
| FaxNumber: | 5094931368 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/11/2007 | ||||||||
| LastUpdateDate: | 10/18/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | A96759 | CA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 500614175 | 05 | OR | MEDICAID |