Provider Demographics
NPI:1588790422
Name:ERFORD, SHELLY (MD)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:ERFORD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8049 NE 28TH ST
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:WA
Mailing Address - Zip Code:98039-1557
Mailing Address - Country:US
Mailing Address - Phone:503-381-7439
Mailing Address - Fax:
Practice Address - Street 1:8049 NE 28TH ST
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:WA
Practice Address - Zip Code:98039-1557
Practice Address - Country:US
Practice Address - Phone:503-381-7439
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA92213208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZP4310ZMedicare ID - Type Unspecified