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Individual
ERIC SUPER
Active
Individual
ERIC SUPER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
171000000X
Military Health Care Provider
0101270191
VA
2081S0010X
Sports Medicine (Physical Medicine & Rehabilitation) Physician
Primary
1071
VA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/05/2019
Last updated
08/25/2025
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