MEDICARE: DR. ERINE ELIZABETH ERICKSON MD

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	207R00000X	Internal Medicine Physician	58649	AZ
2	207R00000X	Internal Medicine Physician	C55260	CA
3	207R00000X	Internal Medicine Physician	27149	NV

General Provider Information

NPI Number	:	1548249808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERINE ELIZABETH ERICKSON MD

Provider Business Mailing Address
First Line	:	PO BOX 33269
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85067-3269
Country	:	US
Telephone Number	:	602-406-4786
Fax Number	:	916-636-4358

Provider Business Practice Location Address
First Line	:	6111 S BUFFALO DR STE 320
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89113-2329
Country	:	US
Telephone Number	:	805-888-7569
Fax Number	:

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

Provider Enumeration Date	:	01/13/2006
Last Update Date	:	07/30/2025

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