Individual
MR. ERIC JIVIDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MPAS, PA-C
Contact information
Practice address
13700 CRYSTALFORD CT, CENTREVILLE, VA 20120-2085
(703) 969-4190
Mailing address
13700 CRYSTALFORD CT, CENTREVILLE, VA 20120-2085
(703) 969-4190
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
0110002105
VA
363AM0700X
Medical Physician Assistant
103779
NC
Other
Enumeration date
05/14/2015
Last updated
05/15/2015
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