Provider Demographics
NPI:1124309711
Name:OBERG, ERIN BAGLEY (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:BAGLEY
Last Name:OBERG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 N 200 E
Mailing Address - Street 2:#101
Mailing Address - City:NORTH LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84341
Mailing Address - Country:US
Mailing Address - Phone:435-787-0560
Mailing Address - Fax:
Practice Address - Street 1:ROCKY MOUNTAIN DERMATOLOGY 1760 N 200 E
Practice Address - Street 2:#101
Practice Address - City:NORTH LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84341
Practice Address - Country:US
Practice Address - Phone:435-787-0560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPA1529363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant