Provider Demographics
NPI:1174756118
Name:ERB, ERNEST EUGENE JR (REGISTERED DIETITIAN)
Entity type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:EUGENE
Last Name:ERB
Suffix:JR
Gender:M
Credentials:REGISTERED DIETITIAN
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:3475 ERWIN ROAD
Mailing Address - Street 2:WALLACE CLINIC SUITE 204
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705
Mailing Address - Country:US
Mailing Address - Phone:919-660-6791
Mailing Address - Fax:919-681-0804
Practice Address - Street 1:3475 ERWIN ROAD
Practice Address - Street 2:WALLACE CLINIC SUITE 204
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705
Practice Address - Country:US
Practice Address - Phone:919-660-6791
Practice Address - Fax:919-681-0804
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2009-08-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NCLOOO237133NN1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, Education