Healthcare Provider Details

I. General information

NPI: 1255539284
Provider Name (Legal Business Name): ERICKSON UY LIWANAG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2007
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 MILL ST
RENO NV
89502-1576
US

IV. Provider business mailing address

1155 MILL ST MS M14
RENO NV
89502-1576
US

V. Phone/Fax

Practice location:
  • Phone: 775-982-7878
  • Fax: 775-982-4196
Mailing address:
  • Phone: 775-982-5262
  • Fax: 775-982-4196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number12872
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number12872
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: