1982799292 NPI number — DR. CARL BOYER ERMSHAR JR. M.D.

Table of content: DR. CARL BOYER ERMSHAR JR. M.D. (NPI 1982799292)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982799292 NPI number — DR. CARL BOYER ERMSHAR JR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ERMSHAR
Provider First Name:
CARL
Provider Middle Name:
BOYER
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982799292
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/12/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 ADAMS ST
Provider Second Line Business Mailing Address:
STE 102
Provider Business Mailing Address City Name:
SAINT HELENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94574-1180
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
707-968-2863
Provider Business Mailing Address Fax Number:
707-963-9185

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6 WOODLAND RD
Provider Second Line Business Practice Location Address:
STE 302
Provider Business Practice Location Address City Name:
SAINT HELENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94574-9501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
707-963-8860
Provider Business Practice Location Address Fax Number:
707-963-8861
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  G17012 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ZZZ61447Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: GR0088300 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: ZZZ56084Z . This is a "BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 040017103 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 040017107 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: B005 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: CJ8786 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: CJ8787 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00G170120 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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