MEDICARE: CHRISTOPHER MARK ERIKSEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	27772	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144292673
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER MARK ERIKSEN M.D.

Provider Business Mailing Address
First Line	:	1120 E ELIZABETH ST
Second Line	:	F-101
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4044
Country	:	US
Telephone Number	:	970-221-1177
Fax Number	:	970-416-1969

Provider Business Practice Location Address
First Line	:	1120 E ELIZABETH ST
Second Line	:	F-101
City	:	FORT COLLINS
State	:	CO
Zip	:	80524-4044
Country	:	US
Telephone Number	:	970-221-1177
Fax Number	:	970-416-1969

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2006
Last Update Date	:	06/25/2010

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