Healthcare Provider Details

I. General information

NPI: 1912003922
Provider Name (Legal Business Name): COREY L ERICKSEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 S STATE ST STE 2
CLEARFIELD UT
84015-1210
US

IV. Provider business mailing address

600 S STATE ST STE 2
CLEARFIELD UT
84015-1210
US

V. Phone/Fax

Practice location:
  • Phone: 801-628-8877
  • Fax:
Mailing address:
  • Phone: 801-628-8877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number171802-1204
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: