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General NPI Number Information
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NPI Number | 1114990587
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Entity Type | Individual
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Provider Name | JAY C. ERICKSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 02/08/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1608 S J ST FL 5
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City | TACOMA
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State | WA
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Zip | 98405-4930
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Country | US
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Telephone | 253-274-7505
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Fax | 253-274-7947
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Provider Business Mailing Address
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Address Line | 1608 S J ST FL 5
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City | TACOMA
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State | WA
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Zip | 98405-4930
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Country | US
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Telephone | 253-274-7505
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Fax | 253-274-7947
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 01052312A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | MD60823049
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License Number State | WA
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