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NPI Code Detail

MEDICARE: DR. BRIAN ALLAN ERICKSON M.D.

MEDICARE: DR. BRIAN ALLAN ERICKSON M.D.
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
1208600000XSurgery Physician2005026717MO
2207P00000XEmergency Medicine PhysicianMD2014-0814NM
3208G00000XThoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianDR.0051687CO

General Provider Information

NPI Number : 1629064225
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRIAN ALLAN ERICKSON M.D.
Provider Business Mailing Address
First Line : 2222 N NEVADA AVE
Second Line : STE 5011
City : COLORADO SPRINGS
State : CO
Zip : 80907-6819
Country : US
Telephone Number : 719-776-7600
Fax Number : 719-473-3553
Provider Business Practice Location Address
First Line : 2222 N NEVADA AVE
Second Line : STE 5011
City : COLORADO SPRINGS
State : CO
Zip : 80907-6819
Country : US
Telephone Number : 719-776-7600
Fax Number : 719-473-3553
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/20/2005
Last Update Date : 12/03/2014

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