Provider Demographics
NPI:1902121932
Name:MEDINA, ERIN ROSE (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIN
Middle Name:ROSE
Last Name:MEDINA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:ROSE
Other - Last Name:RUNDQUIST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 3649
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99220-3649
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:400 S JEFFERSON ST STE 109E
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-3121
Practice Address - Country:US
Practice Address - Phone:509-934-2210
Practice Address - Fax:509-215-3224
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-01
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-PHYS-LIC-21997207Q00000X
WAMD60683659207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine