Healthcare Provider Details

I. General information

NPI: 1427095967
Provider Name (Legal Business Name): ERIK ST. PIERRE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E DIXIE AVE
LEESBURG FL
34748-5925
US

IV. Provider business mailing address

4 ASHBURY PL
MASSENA NY
13662-1647
US

V. Phone/Fax

Practice location:
  • Phone: 352-323-5762
  • Fax:
Mailing address:
  • Phone: 315-769-3811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberME163641
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number204119
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME163641
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: