Provider Demographics
NPI:1982799292
Name:ERMSHAR, CARL BOYER JR (MD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:BOYER
Last Name:ERMSHAR
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1001 ADAMS ST
Mailing Address - Street 2:STE 102
Mailing Address - City:SAINT HELENA
Mailing Address - State:CA
Mailing Address - Zip Code:94574-1180
Mailing Address - Country:US
Mailing Address - Phone:707-968-2863
Mailing Address - Fax:707-963-9185
Practice Address - Street 1:6 WOODLAND RD
Practice Address - Street 2:STE 302
Practice Address - City:SAINT HELENA
Practice Address - State:CA
Practice Address - Zip Code:94574-9501
Practice Address - Country:US
Practice Address - Phone:707-963-8860
Practice Address - Fax:707-963-8861
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2012-06-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG17012207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ61447ZOtherBLUE SHIELD
CAGR0088300Medicaid
CAZZZ56084ZOtherBLUE SHIELD
040017103OtherRAILROAD MEDICARE
040017107OtherRAILROAD MEDICARE
B005OtherTRICARE
CJ8786OtherRAILROAD MEDICARE
CJ8787OtherRAILROAD MEDICARE
CA00G170120Medicaid
A90467Medicare UPIN
CJ8787OtherRAILROAD MEDICARE
CJ8786OtherRAILROAD MEDICARE
CAGR0088300Medicaid
040017107OtherRAILROAD MEDICARE