Provider Demographics
NPI:1497162143
Name:DOLASH, ERIC M (PA-C)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:M
Last Name:DOLASH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2400
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50704-2400
Mailing Address - Country:US
Mailing Address - Phone:319-234-6000
Mailing Address - Fax:319-234-6001
Practice Address - Street 1:3741 PHEASANT LN
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50701-5215
Practice Address - Country:US
Practice Address - Phone:319-234-6000
Practice Address - Fax:319-234-6001
Is Sole Proprietor?:No
Enumeration Date:2014-07-15
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA073312363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant