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: 10/24/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7400 E OSBORN RD
SCOTTSDALE AZ
85251-6432
US

IV. Provider business mailing address

PO BOX 2710
SCOTTSDALE AZ
85252-2710
US

V. Phone/Fax

Practice location:
  • Phone: 480-882-6359
  • Fax:
Mailing address:
  • Phone: 480-882-6359
  • Fax: 480-882-4389

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: