Provider Demographics
NPI:1558322032
Name:APPLEGATE, ERYN BETHANY (MD)
Entity type:Individual
Prefix:
First Name:ERYN
Middle Name:BETHANY
Last Name:APPLEGATE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ERYN
Other - Middle Name:BETHANY
Other - Last Name:MUNKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 4825
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4825
Mailing Address - Country:US
Mailing Address - Phone:360-882-2778
Mailing Address - Fax:
Practice Address - Street 1:2525 NE 139TH ST STE 270
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98686-2719
Practice Address - Country:US
Practice Address - Phone:360-882-2778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-01
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO43546207V00000X
ORMD165795207V00000X
WAMD61369666207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500668648Medicaid
WA2232601Medicaid
CO802387Medicare ID - Type Unspecified