MEDICARE: DR. JUDITH G 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	207Q00000X	Family Medicine Physician	L2875	TX

General Provider Information

NPI Number	:	1821029307
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDITH G ERICKSON MD

Provider Business Mailing Address
First Line	:	14860 MONTFORT DR
Second Line	:	SUITE 115, LB 32
City	:	DALLAS
State	:	TX
Zip	:	75254-6873
Country	:	US
Telephone Number	:	214-550-1469
Fax Number	:	214-446-6010

Provider Business Practice Location Address
First Line	:	14860 MONTFORT DR
Second Line	:	SUITE 115, LB 32
City	:	DALLAS
State	:	TX
Zip	:	75254-6873
Country	:	US
Telephone Number	:	469-431-5656
Fax Number	:	877-658-8663

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	05/25/2021

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