Healthcare Provider Details

I. General information

NPI: 1831909266
Provider Name (Legal Business Name): SCOTT A. ERICKSON, M.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 MEDICAL DR STE 3
BOUNTIFUL UT
84010-5174
US

IV. Provider business mailing address

280 S MAIN ST
BOUNTIFUL UT
84010-6236
US

V. Phone/Fax

Practice location:
  • Phone: 801-505-0821
  • Fax:
Mailing address:
  • Phone: 801-505-0821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number
License Number State

VIII. Authorized Official

Name: SCOTT ERICKSON
Title or Position: MD/OWNER
Credential:
Phone: 801-294-8288