Individual
ERIC EBAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
840 E HILL AVE, MOSES LAKE, WA 98837-2238
(509) 663-8711
Mailing address
840 E HILL AVE, MOSES LAKE, WA 98837-2238
(509) 663-8711
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
94-07682
KS
208600000X
Surgery Physician
Primary
OP60646987
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1750676490
—
WA
01
—
P01665989
RR PTAN WVH
WA
Enumeration date
06/10/2011
Last updated
06/15/2022
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