Healthcare Provider Details

I. General information

NPI: 1760776769
Provider Name (Legal Business Name): BRYAN JAMES ERIKSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2011
Last Update Date: 10/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2018 CLINCH AVE
KNOXVILLE TN
37916
US

IV. Provider business mailing address

2018 CLINCH AVE
KNOXVILLE TN
37916-2301
US

V. Phone/Fax

Practice location:
  • Phone: 800-526-9937
  • Fax: 706-721-7531
Mailing address:
  • Phone: 800-526-9937
  • Fax: 706-721-7531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number74421
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberLL33534
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number57150
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: