MEDICARE: ERIK BJORNDAL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	DO3176	NV

General Provider Information

NPI Number	:	1487150454
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERIK BJORNDAL

Provider Business Mailing Address
First Line	:	1308 ANDREW DAVID AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89086-1346
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1308 ANDREW DAVID AVE
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89086-1346
Country	:	US
Telephone Number	:	713-322-3644
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2018
Last Update Date	:	07/05/2022

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