Healthcare Provider Details

I. General information

NPI: 1225001365
Provider Name (Legal Business Name): ROBERT ERICKSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/09/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2916 E BROADWAY BLVD
TUCSON AZ
85716-5312
US

IV. Provider business mailing address

575 E RIVER RD
TUCSON AZ
85704-5822
US

V. Phone/Fax

Practice location:
  • Phone: 520-874-3500
  • Fax:
Mailing address:
  • Phone: 520-874-3500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number19269
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: