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General NPI Number Information
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NPI Number | 1326392168
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Entity Type | Organization
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Legal Business Name | JOEL S. ERICKSON, M.D., INC.
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Dates
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Enumeration Date | 11/01/2012
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Last Update Date | 11/01/2012
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Provider Practice Location Address
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Address Line | 165 ROWLAND WAY STE 212
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City | NOVATO
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State | CA
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Zip | 94945-5055
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Country | US
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Telephone | 415-892-9550
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Fax |
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Provider Business Mailing Address
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Address Line | 165 ROWLAND WAY STE 212
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City | NOVATO
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State | CA
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Zip | 94945-5055
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Country | US
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Telephone | 415-892-9550
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOEL S. ERICKSON
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Credential | M.D.
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Telephone | 415-892-9550
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | G54218
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License Number State | CA
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