Healthcare Provider Details

I. General information

NPI: 1093796625
Provider Name (Legal Business Name): ERIK O ESPER D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2005
Last Update Date: 02/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2820 W 12TH ST
ERIE PA
16505-4204
US

IV. Provider business mailing address

2820 W 12TH ST
ERIE PA
16505-4204
US

V. Phone/Fax

Practice location:
  • Phone: 814-833-8800
  • Fax: 814-833-2079
Mailing address:
  • Phone: 814-833-8800
  • Fax: 814-833-2079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS007881L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: