Healthcare Provider Details

I. General information

NPI: 1457443673
Provider Name (Legal Business Name): BRIAN ERICKSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SAINT JOHNS BLVD
MAPLEWOOD MN
55109-1183
US

IV. Provider business mailing address

1600 SAINT JOHNS BLVD
MAPLEWOOD MN
55109-1183
US

V. Phone/Fax

Practice location:
  • Phone: 651-232-5354
  • Fax: 651-232-5217
Mailing address:
  • Phone: 651-232-5354
  • Fax: 651-232-5217

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number34586
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number34586
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: