Healthcare Provider Details

I. General information

NPI: 1972500882
Provider Name (Legal Business Name): SCOTT A ERICKSON MD, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 MEDICAL DR STE 4
BOUNTIFUL UT
84010-4951
US

IV. Provider business mailing address

440 MEDICAL DR SUITE 4
BOUNTIFUL UT
84010-4950
US

V. Phone/Fax

Practice location:
  • Phone: 801-294-8288
  • Fax: 801-294-8488
Mailing address:
  • Phone: 801-294-8288
  • Fax: 801-294-8488

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: SCOTT A ERICKSON
Title or Position: MEDICAL DOCTOR
Credential: MD
Phone: 801-294-8288