Healthcare Provider Details

I. General information

NPI: 1952334914
Provider Name (Legal Business Name): ERICKSON PAGE LOVETT P.A-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 09/24/2026
Certification Date: 09/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 S IDAHO RD STE 140
APACHE JUNCTION AZ
85119-0006
US

IV. Provider business mailing address

95 S IDAHO RD STE 140
APACHE JUNCTION AZ
85119-0006
US

V. Phone/Fax

Practice location:
  • Phone: 623-255-1101
  • Fax: 623-444-2784
Mailing address:
  • Phone: 623-255-1101
  • Fax: 623-444-2784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA18305
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3456
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: