Healthcare Provider Details

I. General information

NPI: 1437734530
Provider Name (Legal Business Name): ERIK MARSH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2021
Last Update Date: 03/10/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2168 FIELD HOUSE DR
USAF ACADEMY CO
80840-9599
US

IV. Provider business mailing address

2168 FIELD HOUSE DR
USAF ACADEMY CO
80840-9599
US

V. Phone/Fax

Practice location:
  • Phone: 719-333-0219
  • Fax:
Mailing address:
  • Phone: 719-333-0219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081S0010X
TaxonomySports Medicine (Physical Medicine & Rehabilitation) Physician
License NumberAT.0001673
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: