Provider Demographics
NPI:1881693919
Name:ERWIN, MARK J (PA-C)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:J
Last Name:ERWIN
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:9631 N NEVADA ST
Mailing Address - Street 2:STE 210
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1197
Mailing Address - Country:US
Mailing Address - Phone:509-319-2431
Mailing Address - Fax:877-568-2402
Practice Address - Street 1:5633 N LIDGERWOOD ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99208-1224
Practice Address - Country:US
Practice Address - Phone:509-252-6336
Practice Address - Fax:509-252-6337
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2016-03-30
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Provider Licenses
StateLicense IDTaxonomies
WAPA10004364363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8331779Medicaid
WA8331779Medicaid
P79466Medicare UPIN