Healthcare Provider Details

I. General information

NPI: 1871598508
Provider Name (Legal Business Name): HEIDI ERICKSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2005
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 LINTON BLVD SUITE D502A
DELRAY BEACH FL
33445-6584
US

IV. Provider business mailing address

4800 LINTON BLVD SUITE D502A
DELRAY BEACH FL
33445-6584
US

V. Phone/Fax

Practice location:
  • Phone: 561-808-7205
  • Fax: 561-584-6804
Mailing address:
  • Phone: 561-808-7205
  • Fax: 561-584-6804

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number30665
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number30665
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number30665
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.073211
License Number StateOK
# 5
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME115146
License Number StateFL
# 6
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME115146
License Number StateFL
# 7
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME115146
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: