Healthcare Provider Details

I. General information

NPI: 1952350431
Provider Name (Legal Business Name): TRAVIS ERICKSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 01/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 LYLE RIDGE CIR
OAK HARBOR WA
98277-7642
US

IV. Provider business mailing address

960 LYLE RIDGE CIR
OAK HARBOR WA
98277-7642
US

V. Phone/Fax

Practice location:
  • Phone: 360-969-4191
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOP60369961
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: