Healthcare Provider Details

I. General information

NPI: 1376868158
Provider Name (Legal Business Name): ERIK JUSTIN RASMUSSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2010
Last Update Date: 04/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 FISHER ST
KEESLER AFB MS
39534-2508
US

IV. Provider business mailing address

301 FISHER ST
KEESLER AFB MS
39534-2508
US

V. Phone/Fax

Practice location:
  • Phone: 228-376-0420
  • Fax:
Mailing address:
  • Phone: 228-376-0420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number48782
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: