Healthcare Provider Details

I. General information

NPI: 1629064225
Provider Name (Legal Business Name): BRIAN ALLAN ERICKSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 12/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 N NEVADA AVE STE 5011
COLORADO SPRINGS CO
80907-6819
US

IV. Provider business mailing address

2222 N NEVADA AVE STE 5011
COLORADO SPRINGS CO
80907-6819
US

V. Phone/Fax

Practice location:
  • Phone: 719-776-7600
  • Fax: 719-473-3553
Mailing address:
  • Phone: 719-776-7600
  • Fax: 719-473-3553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2005026717
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD2014-0814
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberDR.0051687
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: