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General NPI Number Information
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NPI Number | 1932283231
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Entity Type | Individual
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Provider Name | JAY ROGER ERICKSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 11/13/2007
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Provider Practice Location Address
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Address Line | 1717 N E ST SUITE 439
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City | PENSACOLA
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State | FL
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Zip | 32501-6339
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Country | US
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Telephone | 850-432-3692
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Fax | 800-918-3765
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Provider Business Mailing Address
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Address Line | 1717 N E ST SUITE 439
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City | PENSACOLA
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State | FL
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Zip | 32501-6339
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Country | US
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Telephone | 850-432-3692
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Fax | 800-918-3765
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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 | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | ME0067313
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License Number State | FL
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